Variceal haemorrhage is a common and serious complication of portal hypertension. Endoscopic therapy is successful in the majority in controlling bleeding but in those who continue to bleed transjugular intrahepatic portosystemic stent shunt is highly effective in achieving haemostasis, although the evidence base that this is associated with improved survival is limited. This review discusses initial management and then the particular role of transjugular intrahepatic portosystemic stent shunt. A management algorithm is proposed. The timing of intervention is emphasized and the importance of admission to specialized centres. Regional protocols are probably essential for the latter to be organized effectively.
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