Materiały źródłowe

• #1 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-images

  Esophageal varices are submucosal distal esophageal veins, connecting the portal circulation and systemic circulation, that are dilated because of portal hypertension, most commonly because of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. […] The gold-standard for evaluation of esophageal varices is esophagogastroduodenoscopy, but radiographic modalities, such as CT, MRI, and ultrasonography, have been studied as noninvasive means of diagnosing esophageal varices and evaluating the risk of bleeding. Esophageal and paraesophageal varices have been identified on contrast-enhanced cross-sectional imaging as torturous, enlarged, smooth tubular structures. […] When esophageal varices are discovered, they are graded according to their size, as follows: Grade 1 Small, straight esophageal varices; Grade 2 Enlarged, tortuous esophageal varices occupying less than one third of the lumen; Grade 3 Large, coil-shaped esophageal varices occupying more than one third of the lumen.

• #1 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. […] Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. […] However, upper endoscopy is not recommended for patients with liver stiffness 20 KPa and platelet count 150 109/L as there is a low probability of high-risk varices. […] Despite the presence of clinical and/or imaging findings of PH, the gold standard for the diagnosis of EV and gastric varices (GV) is esophagogastroduodenoscopy (EGD). […] The primary goal of EGD is the diagnosis and risk stratification of EV and GV by determining the size and high-risk stigmata. […] Esophageal varices are classified by size (small, medium, or large) and by the presence of red wale marks, while GV are classified as gastroesophageal varices (GOV) or isolated gastric varices (IGV).

• #2 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. […] Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. […] However, upper endoscopy is not recommended for patients with liver stiffness 20 KPa and platelet count 150 109/L as there is a low probability of high-risk varices. […] Despite the presence of clinical and/or imaging findings of PH, the gold standard for the diagnosis of EV and gastric varices (GV) is esophagogastroduodenoscopy (EGD). […] The primary goal of EGD is the diagnosis and risk stratification of EV and GV by determining the size and high-risk stigmata. […] Esophageal varices are classified by size (small, medium, or large) and by the presence of red wale marks, while GV are classified as gastroesophageal varices (GOV) or isolated gastric varices (IGV).

• #2 WGO Esophageal Varices Guideline Summary

  https://www.guidelinecentral.com/guideline/1090246/

  Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. […] If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although this is a poor second choice, it can certainly demonstrate the presence of varices. Further alternatives include radiography/barium swallow of the esophagus and stomach, and portal vein angiography and manometry. […] It is important to assess the location (esophagus or stomach) and size of the varices, signs of imminent, first acute, or recurrent bleeding, and (if applicable) to consider the cause and severity of liver disease.

• #3 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] If someone is diagnosed with cirrhosis, a healthcare professional will then typically screen for esophageal varices. How often screening tests are done depends on someone’s condition. The main tests used to diagnose esophageal varices are: […] An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. This procedure is the preferred method of screening for esophageal varices. The tiny camera lets a medical professional examine the esophagus, stomach and the beginning of the small intestine, called the duodenum.

• #4 Esophageal varices – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/esophageal-varices/

  Esophageal varices are dilated collateral veins resulting from increased blood flow due to portal hypertension, often caused by cirrhosis. Screening for varices with esophagogastroduodenoscopy (EGD) is recommended at the time of cirrhosis diagnosis. […] Diagnosis and surveillance of esophageal varices requires esophagogastroduodenoscopy (EGD), with the goal of establishing: [2] […] Presence of varices […] Size of varices […] Stigmata of recent or impending bleeding (i.e., high-risk endoscopic findings): [4][7] […] Red wale marks: longitudinal red streaks on the surface of a varix […] Cherry-red spots […] Hematocystic spots: raised spots that appear as blisters. […] Imaging is not routinely indicated but large esophageal varices may be incidentally identified. […] Transient elastography and CBC may be used to rule out high-risk esophageal varices but are not routinely used for confirming the diagnosis.

• #5 Diagnosis of Esophageal Varices | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4939-0002-2_3

  Diagnosing and grading esophageal varices are mainstays in the management of patients with chronic liver disease. Esophagogastroduodenoscopy (EGD) is, at present, the gold standard for diagnosis, and must be performed in all patients when the diagnosis of cirrhosis is established and repeated every 2-3 years if no varices are found, or even earlier if decompensation occurs. […] However, none of them has entered clinical practice, due to lack of accuracy or of adequate validation. Therefore EGD, although non-cost-effective in compensated cirrhotic patients, cannot at present be replaced by other tests in the diagnosis and grading of esophageal varices.

• #6 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  The professional doing the endoscopy looks for dilated veins. If found, the enlarged veins are measured and checked for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam. […] Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices. An ultrasound test called transient elastography may be used to measure scarring in the liver. This can help determine if someone has portal hypertension, which may lead to esophageal varices. […] After initial banding treatment, a healthcare professional will repeat an upper endoscopy at regular intervals. If necessary, more banding may be done until the esophageal varices are gone or are small enough to reduce the risk of further bleeding.

• #7 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-images

  Esophageal varices are submucosal distal esophageal veins, connecting the portal circulation and systemic circulation, that are dilated because of portal hypertension, most commonly because of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. […] The gold-standard for evaluation of esophageal varices is esophagogastroduodenoscopy, but radiographic modalities, such as CT, MRI, and ultrasonography, have been studied as noninvasive means of diagnosing esophageal varices and evaluating the risk of bleeding. Esophageal and paraesophageal varices have been identified on contrast-enhanced cross-sectional imaging as torturous, enlarged, smooth tubular structures. […] When esophageal varices are discovered, they are graded according to their size, as follows: Grade 1 Small, straight esophageal varices; Grade 2 Enlarged, tortuous esophageal varices occupying less than one third of the lumen; Grade 3 Large, coil-shaped esophageal varices occupying more than one third of the lumen.

• #8 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-images

  The grading of esophageal varices and identification of red wheals by endoscopy predict a patient’s bleeding risk, on which treatment is based. […] CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. […] Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique. Therefore, imaging modalities such as CT scanning, MRI, and EUS are also performed for a more complete evaluation. […] The American Association for the Study of Liver Diseases (AASLD) and the Baveno VI consensus statement have recommended the use of noninvasive tests to stratify patients and rule out high-risk esophageal varices. According to the Baveno VI consensus statement, patients with liver stiffness greater than 20 kPa and a platelet count greater than 150,000 uL have a very low risk of clinically significant varices.

• #9 Esophageal Varices: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices

  Esophageal varices are swollen veins in the lining of your esophagus. […] They usually occur with liver disease. […] Most treatment is aimed at damage control. […] Esophageal varices occur in people with portal hypertension, which is high blood pressure in the portal vein that runs through your liver and the other veins that branch off from it. […] A healthcare provider will evaluate your symptoms and health history, including any current or chronic conditions. An initial physical exam may show signs of bleeding, blood loss or liver disease. […] If you dont have signs of active bleeding, your provider might begin with noninvasive imaging tests, such as a CT scan, magnetic resonance angiogram (MRA) or Doppler ultrasound, to look at your blood vessels and blood flow. […] An upper endoscopy (also called an EGD test) is an examination of your upper gastrointestinal tract.

• #10 Esophageal varix | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/oesophageal-varix?lang=us

  Esophageal varices describe dilated submucosal veins of the esophagus, and are an important portosystemic collateral pathway. They are considered distinct from gastric varices, which are less common. […] The gold-standard investigation for the evaluation of esophageal varices is esophagogastroduodenoscopy, however radiographic investigations may serve as a useful adjunct. […] Esophageal varices may be visible on plain radiograph if they are large. In such instances, they will have a non-specific appearance of a mass in the posterior mediastinum. […] Barium swallow may reveal longitudinal esophageal luminal filling defects, representing esophageal varices. […] Esophageal and paraesophageal varices are readily visible on contrast-enhanced cross-sectional imaging, as torturous, enlarged, smooth enhancing tubular structures. […] Digital subtraction angiography can also be a useful imaging modality in the assessment of esophageal and paraesophageal varices, providing direct visualization through catheterization and contrast injection of the left gastric vein.

• #11 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-images

  The grading of esophageal varices and identification of red wheals by endoscopy predict a patient’s bleeding risk, on which treatment is based. […] CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. […] Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique. Therefore, imaging modalities such as CT scanning, MRI, and EUS are also performed for a more complete evaluation. […] The American Association for the Study of Liver Diseases (AASLD) and the Baveno VI consensus statement have recommended the use of noninvasive tests to stratify patients and rule out high-risk esophageal varices. According to the Baveno VI consensus statement, patients with liver stiffness greater than 20 kPa and a platelet count greater than 150,000 uL have a very low risk of clinically significant varices.

• #12 Computed tomography for the diagnosis of gastroesophageal varices and risk assessment in patients with cirrhosis: a systematic review and meta-analysis – Diagnostic and Interventional Radiology

  https://dirjournal.org/articles/computed-tomography-for-the-diagnosis-of-gastroesophageal-varices-and-risk-assessment-in-patients-with-cirrhosis-a-systematic-review-and-meta-analysis/doi/dir.2024.242723

  PURPOSE This meta-analysis aimed to evaluate the diagnostic accuracy of computed tomography (CT) for detecting gastroesophageal varices (GEVs) and identify high-risk GEVs in patients with cirrhosis. […] CT demonstrates promising diagnostic accuracy for identifying gastroesophageal varices and distinguishing high-risk GEVs in patients with cirrhosis. […] The pooled SEN, SPE, PLR, NLR, DOR, and AUC of CT-based diagnosis were estimated at 0.91 (0.92), 0.81 (0.45), 4.82 (1.67), 0.11 (0.17), 42.47 (10.26), and 0.93 (0.94), respectively, for any GEV and at 0.89 (0.89), 0.90 (0.79), 8.86 (4.28), 0.12 (0.14), 75.71 (30.19), and 0.95 (0.85), respectively, for high-risk GEVs. […] CT has a relatively high sensitivity and specificity in detecting GVs of any size, and a relatively high sensitivity and extremely high specificity in detecting large GVs.

• #13 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  The professional doing the endoscopy looks for dilated veins. If found, the enlarged veins are measured and checked for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam. […] Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices. An ultrasound test called transient elastography may be used to measure scarring in the liver. This can help determine if someone has portal hypertension, which may lead to esophageal varices. […] After initial banding treatment, a healthcare professional will repeat an upper endoscopy at regular intervals. If necessary, more banding may be done until the esophageal varices are gone or are small enough to reduce the risk of further bleeding.

• #14 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Elastography has been introduced in recent decades as a non-invasive method of determining the degree of liver stiffness. […] According to some studies, liver stiffness combined with platelet count accurately identifies patients with a low (5%) risk of EV in patients with compensated cirrhosis. […] As a consequence, Baveno VII guidelines do not recommend upper endoscopy for the screening of EV in patients with liver stiffness less than 20 kPa and platelet counts greater than 150 109/L. […] The accuracy of EGD in the detection and characterization of EV can be further improved by integrating artificial intelligence (AI). […] A new statement added to Baveno VII recommends that patients with compensated ACLD on nonselective beta-blocker (NSBB) therapy who have no visible CSPH (LSM 25 kPa) after the removal/suppression of the primary etiological factor undergo a repeat EGD within 12 years.

• #15 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-images

  The grading of esophageal varices and identification of red wheals by endoscopy predict a patient’s bleeding risk, on which treatment is based. […] CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. […] Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique. Therefore, imaging modalities such as CT scanning, MRI, and EUS are also performed for a more complete evaluation. […] The American Association for the Study of Liver Diseases (AASLD) and the Baveno VI consensus statement have recommended the use of noninvasive tests to stratify patients and rule out high-risk esophageal varices. According to the Baveno VI consensus statement, patients with liver stiffness greater than 20 kPa and a platelet count greater than 150,000 uL have a very low risk of clinically significant varices.

• #16 Esophageal varices – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/esophageal-varices/

  Capsule endoscopy. In this test, you swallow a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through your digestive tract. This might be an option for people who are unable or unwilling to have an endoscopic exam. This technology is more expensive than regular endoscopy and not as available. Capsule endoscopy can only help find esophageal varices and does not treat them.

• #17 Diagnosis and Management of Esophagogastric Varices

  https://www.mdpi.com/2075-4418/13/6/1031

  Notably, for patients with virally induced liver disease (i.e., HCV, HBV, etc.), the Baveno VI criteria (i.e., liver stiffness measured (LSM) < 20 kPa and PLT > 150 × 10^9/L) can be used to manage ACLD after the primary etiological factor has been removed, thereby ruling out high-risk varices in patients with compensated liver disease who achieved SVR and viral suppression. […] The accuracy of EGD in the detection and characterization of EV can be further improved by integrating artificial intelligence (AI). […] Video capsule endoscopy (VCE) has been proposed as an alternative method for grading EV (especially the esophageal capsule system). […] The endoscopic management of EV can be divided into three scenarios: the role in preventing first variceal bleeding (primary prophylaxis), the treatment of AVB, and prophylaxis for re-bleeding after the first hemorrhaging event (secondary prophylaxis).

• #18

  https://www.xiahepublishing.com/2310-8819/JCTH-2023-00061

  Gastroscopy is the gold standard for diagnosing GOV and EVB. As an invasive examination, it remains the primary method for detecting GOV and assessing the risk of EVB. […] HVPG is an effective method for assessing the risk of portal hypertension. Portal hypertension is defined as an HVPG of 5 mmHg (normal range, 3-5 mmHg). HVPG 10 mmHg is a predictor of varicose vein formation and decompensation of liver cirrhosis, with HVPG 20 mmHg indicating a poor prognosis. […] The main purpose of these guidelines is to help clinicians specializing in liver diseases, gastrointestinal diseases, or infectious diseases in tier two and above hospitals make appropriate decisions on the diagnosis and treatment of EVB. However, the guideline is not mandatory standards and cannot include or resolve all problems in the diagnosis and treatment of upper gastrointestinal bleeding in cirrhosis. Therefore, while caring for every patient, clinicians should follow the principles of this guideline, fully understand the disease condition, seriously consider the views and wishes of the patient, and develop a comprehensive and individualized diagnosis and treatment plan based on local medical resources and practical experience.

• #19 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. […] Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. […] However, upper endoscopy is not recommended for patients with liver stiffness 20 KPa and platelet count 150 109/L as there is a low probability of high-risk varices. […] Despite the presence of clinical and/or imaging findings of PH, the gold standard for the diagnosis of EV and gastric varices (GV) is esophagogastroduodenoscopy (EGD). […] The primary goal of EGD is the diagnosis and risk stratification of EV and GV by determining the size and high-risk stigmata. […] Esophageal varices are classified by size (small, medium, or large) and by the presence of red wale marks, while GV are classified as gastroesophageal varices (GOV) or isolated gastric varices (IGV).

• #20 Diagnosis and Management of Esophagogastric Varices

  https://www.mdpi.com/2075-4418/13/6/1031

  Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. […] Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. However, upper endoscopy is not recommended for patients with liver stiffness < 20 KPa and platelet count > 150 × 10^9/L as there is a low probability of high-risk varices. […] Despite the presence of clinical and/or imaging findings of PH, the gold standard for the diagnosis of EV and gastric varices (GV) is esophagogastroduodenoscopy (EGD). […] The primary goal of EGD is the diagnosis and risk stratification of EV and GV by determining the size and high-risk stigmata. […] Elastography has been introduced in recent decades as a non-invasive method of determining the degree of liver stiffness.

• #21 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Upper GI endoscopy should be used to identify high-risk EV (medium or large EV, or small EV with red wale marks) in patients with decompensated ACLD and LSM 20 KPa or platelet count 150 109/L. […] Patients who are not candidates for screening endoscopy can be monitored with yearly TE and platelet counts. […] Baveno VII guidelines recently recommended endoscopic band ligation to prevent first variceal bleeding in compensated patients with high-risk varices who have contraindications or intolerance to NSBBs. […] The rupture of esophageal varices presents with severe hemorrhage, characterized by hematemesis and/or melena, severe anemia, and possible loss of consciousness. […] According to the European Society of Gastrointestinal Endoscopy, patients with ACLD who present with suspected AVB should be risk stratified using the ChildPugh and MELD scores, as well as the documentation of active/inactive bleeding at the time of upper GI endoscopy.

• #22 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] If someone is diagnosed with cirrhosis, a healthcare professional will then typically screen for esophageal varices. How often screening tests are done depends on someone’s condition. The main tests used to diagnose esophageal varices are: […] An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. This procedure is the preferred method of screening for esophageal varices. The tiny camera lets a medical professional examine the esophagus, stomach and the beginning of the small intestine, called the duodenum.

• #23 Patient education: Esophageal varices (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print

  If no esophageal varices are detected, experts usually recommend repeating the upper endoscopy in one to three years. […] If large varices are detected, a medication is prescribed to reduce the risk of bleeding, and the endoscopy does not usually need to be repeated. […] If small esophageal varices are detected, although the risk of bleeding is much lower than with large varices, medication is frequently recommended because it may prevent the development of other complications of portal hypertension. […] The timing of repeat endoscopy depends upon the appearance of the varices, the cause of the liver disease, and the person’s overall health. […] Other tests — Although other screening methods have been studied, alternatives to upper endoscopy are not routinely used because they are less accurate.

• #24 Esophageal Varices

  https://mobile.fpnotebook.com/GI/Esophagus/EsphglVrcs.htm

  Incidence: 30-70% of Cirrhosis cases […] Bleeding occurs within first year of Esophageal Varices diagnosis in 30% of cases […] Initial: Endoscopy for all patients with Cirrhosis […] Repeat screening […] No Varices: Repeat every 3 years […] Small Varices: Yearly […] Large Varices: Per endoscopist discretion […] Endoscopic ligation or banding (preferred, first-line measure) […] Recommended within 12 hours of onset […] Ligation is superior to sclerotherapy […] Indications […] Hepatic Vein Pressure Gradient (HPVG) 5 mmHg […] Endoscopic criteria […] Large Esophageal Varices […] Small Esophageal Varices […] High Child-Pugh Score […] Varices with red wale markings […] Reduce risk of bleeding from 45% to 22% […] Do not reduce overall mortality from Esophageal Varices

• #25 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  The professional doing the endoscopy looks for dilated veins. If found, the enlarged veins are measured and checked for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam. […] Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices. An ultrasound test called transient elastography may be used to measure scarring in the liver. This can help determine if someone has portal hypertension, which may lead to esophageal varices. […] After initial banding treatment, a healthcare professional will repeat an upper endoscopy at regular intervals. If necessary, more banding may be done until the esophageal varices are gone or are small enough to reduce the risk of further bleeding.

• #26 Diagnosis and Management of Esophagogastric Varices

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10047815/

  Baveno VII recommends that in cases of suspected variceal bleeding, vasoactive drugs (such as terlipressin and octreotide) be started as soon as possible and continued for 25 days. […] Upper endoscopy should be performed on patients with suspected AVB within 12 h of presentation after hemodynamic resuscitation.

• #27 Top Recommendations for the Diagnosis and Management of Esophagogastric Variceal Bleeding – Endoscopy Campus

  https://www.endoscopy-campus.com/en/ec-news/top-recommendations-for-the-diagnosis-and-management-of-esophagogastric-variceal-bleeding/

  Patients with suspected EVH should undergo endoscopic evaluation within 12 hours of presentation, as long as hemodynamic resuscitation has been performed. […] An endoscopic cyanoacrylate injection for acute gastric (cardiofundal) variceal (GOV2, IGV1) hemorrhage should be administered. […] Patients who have undergone EBL for acute EVH should receive follow-up EBLs every 1 to 4 weeks until esophageal varices are eradicated (secondary prophylaxis). […] Early endoscopy in patients with suspected variceal bleeding, use of antibiotics in those with cirrhosis, and consideration of beta blockers for primary prevention are all important strategies to improve patient outcomes.

• #28 Endoscopic diagnosis and management of esophagogastric variceal hemorrhage | ESGE

  https://www.esge.com/endoscopic-diagnosis-and-management-of-esophagogastric-variceal-hemorrhage

  ESGE recommends that patients with ACLD presenting with suspected acute variceal bleeding be risk stratified according to the Child–Pugh score and MELD score, and by documentation of active/inactive bleeding at the time of upper GI endoscopy. Strong recommendation, high quality of evidence. […] ESGE recommends EBL for the treatment of acute esophageal variceal hemorrhage (EVH). Strong recommendation, high quality evidence. […] ESGE recommends that, in patients at high risk for recurrent esophageal variceal bleeding following successful endoscopic hemostasis (Child–Pugh C ≤ 13 or Child–Pugh B > 7 with active EVH at the time of endoscopy despite vasoactive agents, or HVPG > 20mmHg), pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) within 72 hours (preferably within 24 hours) must be considered. Strong recommendation, high quality evidence. […] ESGE recommends that, for persistent esophageal variceal bleeding despite vasoactive pharmacological and endoscopic hemostasis therapy, urgent rescue TIPS should be considered (where available). Strong recommendation, moderate quality evidence.

• #29 Esophageal Varices – The Gastro Clinic

  https://www.gastroclinic.com/conditions/esophageal-varices/

  Esophageal varices are usually a consequence of portal hypertension, commonly found in cirrhosis of the liver patients. […] Diagnosis of esophageal varices includes blood tests, liver and kidney function, and coagulation tests. […] Ultrasound to study blood flow. […] Endoscopy, a small flexible tube with a light and camera inserted into the mouth to the esophagus and stomach to investigate for bleeding and swollen vessels.

• #30 Esophageal varices – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/815

  Esophageal varices are a direct consequence of portal hypertension as a progressive complication of cirrhosis. […] Diagnosis and surveillance are important aspects of management. […] Key diagnostic factors include cirrhosis, severe liver disease, alcohol misuse, hepatitis B or C infection, ascites, spider angioma, caput medusa, jaundice, encephalopathy, hematemesis, melena, hematochezia, and HIV coinfection. […] 1st tests to order include hepatic venous pressure gradient (HPVG), complete blood count, coagulation profile (INR/prothrombin time), serum LFTs, BUN and creatinine, blood typing/cross-matching, hepatitis B surface antigen (HBsAg), anti-hepatitis C virus IgG (anti-HCV IgG), esophago-gastro-duodenoscopy (EGD), and liver stiffness measurement (LSM). […] Emerging tests include capsule endoscopy.

• #31 Oesophageal Varices | Doctor

  https://patient.info/doctor/oesophageal-varices

  Diagnosing oesophageal varices (investigations) […] Endoscopy is required at an early stage. […] FBC – haemoglobin may be low; MCV may be high, normal or low; platelets may also be low; WCC may be raised. Thrombocytopenia may suggest portal hypertension and/or large oesophageal varices. […] Clotting including INR. […] Renal function. […] LFTs. […] BUN (blood urea nitrogen) may be elevated if there has been a bleed. […] Group and cross-match. […] Hepatic serology. […] CXR – patients may have aspirated or have chest infection. […] Ascitic tap may be needed if bacterial peritonitis is suspected. […] Investigations as indication for the underlying cause of portal hypertension (see the separate Portal Hypertension article). […] Imaging […] Various imaging techniques are available to assist in diagnosis, identification of underlying cause and risk factors, and response to treatment. These include:

• #32 Not all varices are from cirrhosis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/news/not-all-varices-are-from-cirrhosis/

  Cirrhosis is the most common cause of portal hypertension and varices in the Western world. However, varices can arise in patients with portal hypertension in the absence of cirrhosis or even in the absence of portal hypertension. This short perspective focuses on varices without cirrhosis, including background information and various diagnosis and treatment options. […] The patient incidentally diagnosed with esophageal varices on upper endoscopy should undergo cross-sectional abdominal imaging with IV contrast. CT or MRI by itself is not sufficiently accurate for the diagnosis of cirrhosis. However, a constellation of findings such as a nodular shrunken liver, ascites, splenomegaly, intra-abdominal varices and a low pre-test probability of a treatable liver condition should dissuade the provider from a liver biopsy. In patients with a normal appearing liver on cross-sectional imaging, patent hepatic and portal veins, and abnormal liver tests, a liver biopsy should be pursued.

• #33 Not all varices are from cirrhosis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/news/not-all-varices-are-from-cirrhosis/

  Downhill varices are usually seen in the upper third of the esophagus in contrast to uphill varices associated with portal hypertension that are seen in the lower third of the esophagus. […] These varices are not treated with non-selective beta-blockers or with banding. […] A gradient of 12 mm Hg or more can lead to variceal hemorrhage. […] For patients with an identifiable cause of non-cirrhotic portal hypertension, such as primary biliary cirrhosis, disease-specific treatment should be initiated.

• #34 Esophageal Varices: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices

  Healthcare providers have several ways of treating varices to prevent and control bleeding. […] The goals of treatment are to: Control active bleeding. Prevent future bleeding. Reduce portal hypertension or prevent it from worsening, if possible. […] Bleeding from esophageal varices is an emergency that requires immediate treatment. […] If youve already been treated for bleeding, or if your varices arent bleeding yet but are at risk, your healthcare provider will offer you preventive treatment. […] Varices sometimes reduce with treatment, especially if portal hypertension can be reduced. But they rarely go away completely. […] Your outlook depends on: Whether you have variceal bleeding. How advanced your liver disease is. […] The risk of mortality from your first episode of variceal bleeding is 20%. […] In 90% of cases, treatment with band ligation controls the bleeding. […] However, the risk of new bleeding is 60%, regardless of treatment. […] Esophageal varices are among the most serious complications of portal hypertension and cirrhosis.

• #35 WGO Esophageal Varices Guideline Summary

  https://www.guidelinecentral.com/guideline/1090246/

  Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. […] If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although this is a poor second choice, it can certainly demonstrate the presence of varices. Further alternatives include radiography/barium swallow of the esophagus and stomach, and portal vein angiography and manometry. […] It is important to assess the location (esophagus or stomach) and size of the varices, signs of imminent, first acute, or recurrent bleeding, and (if applicable) to consider the cause and severity of liver disease.

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