1.   Although there is no extensive published experience in elderly patients, oesophageal transection using a stapling device seems to offer an attractive emergency means of arresting haemorrhage.

2.   In a prospective three centre study oesophageal transection and gastric devascularisation have been compared with endoscopic sclerotherapy in the long term management of bleeding oesophageal varices.

3.   An unexpected finding of this study was the high incidence of recurrent variceal haemorrhage among those patients undergoing oesophageal transection and gastric devascularisation.

4.   Against this, however, was the experience in one patient who had to undergo an emergency gastrectomy for ischaemia after oesophageal transection and gastric devascularisation.

5.   Nevertheless these are likely to be higher for oesophageal transection and gastric devascularisation patients, given the major operation and the long postoperative stay.

6.   In conclusion oesophageal transection and gastric devascularisation appears to confer no benefit over endoscopic sclerotherapy in terms of long term survival after variceal haemorrhage.

7.   A further potential disadvantage of oesophageal transection and gastric devascularisation is that the extensive upper adbonimal surgery may complicate subsequent orthotopic liver transplantation.

8.   The discouraging results of oesophageal transection and gastric devascularisation in this trial do not mean that the operation has no place in the management of variceal bleeding.

9.   Bleeding varices may be controlled initially by pharmacological measures, balloon tamponade, endoscopic sclerotherapy, oesophageal transection, or emergency portasystemic shunt surgery.