The management of acute variceal bleeding is a complex process, which includes general supporting measures, resuscitation, cardiorespiratory monitoring, transfusion, treatment of the bleeding itself and prevention of complications. One frequently encountered difficulty is the pooling of blood near the fundus and the cardia, obscuring the endoscopic view. One method that is useful is to patiently suck out as much of blood from the fundus as possible, and to site the patient up. Blood in the oesophagus and the cardia will gravitate down, giving the opportunity to identify the bleeding points and targeted therapy Occasionally turning the patient to one the right side may expose the fundus.
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