Materiały źródłowe

• #1 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #2 Esophageal Varices | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21350

  Incidence: At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] Prevalence: It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #3 Esophageal Varices | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116220/5.0/Esophageal_Varices

  30% of cirrhotic patients have varices at the time of diagnosis; 90% of cirrhotic patients will have varices at 10 years. […] 1-year rate of first variceal bleeding is 5% for small varices and 15% for large varices. […] 50% of patients with esophageal varices experience bleeding at some point. […] Variceal bleeding: 10-20% mortality in the 6 weeks following the episode.

• #4 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english

  Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 1030% of all cases of upper gastrointestinal bleeding. […] Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 533% of patients with portal hypertension. […] The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis, and 936% of patients have what are known as high-risk varices. Esophageal varices develop in patients with cirrhosis at an annual rate of 58%, but the varices are large enough to pose a risk of bleeding in only 12% of cases. Approximately 430% of patients with small varices will develop large varices each year and will therefore be at risk of bleeding.

• #5 WGO Esophageal Varices Guideline Summary

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

  Although varices may form in any location along the tubular gastrointestinal tract, they most often appear in the distal few centimeters of the esophagus. Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 53-33% of patients with portal hypertension. […] The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis, and 93-96% of patients have what are known as high-risk varices. Esophageal varices develop in patients with cirrhosis at an annual rate of 58%, but the varices are large enough to pose a risk of bleeding in only 12% of cases. Approximately 43-30% of patients with small varices will develop large varices each year and will therefore be at risk of bleeding. […] The presence of gastroesophageal varices correlates with the severity of liver disease.

• #6 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english

  Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 1030% of all cases of upper gastrointestinal bleeding. […] Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 533% of patients with portal hypertension. […] The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis, and 936% of patients have what are known as high-risk varices. Esophageal varices develop in patients with cirrhosis at an annual rate of 58%, but the varices are large enough to pose a risk of bleeding in only 12% of cases. Approximately 430% of patients with small varices will develop large varices each year and will therefore be at risk of bleeding.

• #7 WGO Esophageal Varices Guideline Summary

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

  Although varices may form in any location along the tubular gastrointestinal tract, they most often appear in the distal few centimeters of the esophagus. Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 53-33% of patients with portal hypertension. […] The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis, and 93-96% of patients have what are known as high-risk varices. Esophageal varices develop in patients with cirrhosis at an annual rate of 58%, but the varices are large enough to pose a risk of bleeding in only 12% of cases. Approximately 43-30% of patients with small varices will develop large varices each year and will therefore be at risk of bleeding. […] The presence of gastroesophageal varices correlates with the severity of liver disease.

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

  https://radiopaedia.org/articles/esophageal-varix?embed_domain=external.radpair.com%27%5B0%5D&lang=us

  Esophageal varices are present in ~50% of patients with portal hypertension 1,2. […] They occur in greater frequency in patients with more severe cirrhosis, for example esophageal varices may be present in ~40% of patients with Child-Pugh A cirrhosis, but in ~85% of patients with Child-Pugh C cirrhosis 1,2.

• #9 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english

  The presence of gastroesophageal varices correlates with the severity of liver disease. […] An international normalized ratio (INR) score 1.5, a portal vein diameter of 13 mm, and thrombocytopenia have been found to be predictive of the likelihood of varices being present in cirrhotics. If none, one, two, or all three of these conditions are met, then 10%, 2050%, 4060%, and 90% of the patients are estimated to have varices, respectively. The presence of one or more of these conditions represents an indication for endoscopy to search for varices and carry out primary prophylaxis against bleeding in cirrhotic patients.

• #10 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #11 WGO Esophageal Varices Guideline Summary

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

  Although varices may form in any location along the tubular gastrointestinal tract, they most often appear in the distal few centimeters of the esophagus. Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 53-33% of patients with portal hypertension. […] The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis, and 93-96% of patients have what are known as high-risk varices. Esophageal varices develop in patients with cirrhosis at an annual rate of 58%, but the varices are large enough to pose a risk of bleeding in only 12% of cases. Approximately 43-30% of patients with small varices will develop large varices each year and will therefore be at risk of bleeding. […] The presence of gastroesophageal varices correlates with the severity of liver disease.

• #12 To Band or Not To Band? Esophageal Varices in the Pediatric Population | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/band-or-not-band-esophageal-varices-pediatric

  Extrahepatic portal vein obstruction and biliary atresia are the most common causes of portal hypertension in the pediatric population. […] The overall incidence and mortality of variceal bleeding in children is lower than in adults. […] Primary prophylaxis of esophageal varices with band ligation is not a standard practice. […] Band ligation is the preferred method of endoscopic management of esophageal varices that have bled or have high likelihood of bleeding. Sclerotherapy is used for smaller children (typically 10 kg). […] Surgical shunts are typically recommended for refractory symptoms of portal hypertension. Meso Rex bypass shunts are typically preferred for pediatric patients with EHPVO.

• #13 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #14 Esophageal Varices | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116220/5.0/Esophageal_Varices

  30% of cirrhotic patients have varices at the time of diagnosis; 90% of cirrhotic patients will have varices at 10 years. […] 1-year rate of first variceal bleeding is 5% for small varices and 15% for large varices. […] 50% of patients with esophageal varices experience bleeding at some point. […] Variceal bleeding: 10-20% mortality in the 6 weeks following the episode.

• #15 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #16 Oesophageal Varices | Doctor

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

  The prevalence of oesophageal varices varies between 40% and 95% in people with cirrhosis. […] The annual incidence of oesophageal varices in people with cirrhosis varies from 3% to 22%. […] Oesophageal varices are one of the two most common causes of upper gastrointestinal bleeding (the other being gastric erosions). […] In Western countries, alcoholic and viral cirrhosis are the leading causes of portal hypertension and oesophageal varices. […] The one-year rate of first variceal bleeding is 5% for small varices, and 15% for large varices. […] It is more common in males than in females. […] The mortality rate is 10-20% in the first six weeks after a bleed. […] All patients with newly diagnosed cirrhosis should have screening endoscopy, looking for oesophageal varices. […] Presence of moderate or large varices requires beta-blockers in the first instance (indefinite treatment).

• #17 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #18 Oesophageal Varices | Doctor

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

  The prevalence of oesophageal varices varies between 40% and 95% in people with cirrhosis. […] The annual incidence of oesophageal varices in people with cirrhosis varies from 3% to 22%. […] Oesophageal varices are one of the two most common causes of upper gastrointestinal bleeding (the other being gastric erosions). […] In Western countries, alcoholic and viral cirrhosis are the leading causes of portal hypertension and oesophageal varices. […] The one-year rate of first variceal bleeding is 5% for small varices, and 15% for large varices. […] It is more common in males than in females. […] The mortality rate is 10-20% in the first six weeks after a bleed. […] All patients with newly diagnosed cirrhosis should have screening endoscopy, looking for oesophageal varices. […] Presence of moderate or large varices requires beta-blockers in the first instance (indefinite treatment).

• #19 Diagnosis and Management of Esophagogastric Varices

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

  Esophageal varices (EV) are one of the most common causes of acute upper gastrointestinal bleeding (UGIB) with varying prevalence worldwide. They are the leading cause of death from UGIB. Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension (CSPH) and represents an important economic and population health issue. EV are the seventh most common cause of GI bleeding in the United States, according to the literature. The prevalence of schistosomiasis has been linked to EV in certain parts of the developing world. Cirrhosis is the most common cause of EV in the Western world, with up to 85% of cirrhotic patients developing EV at some point in their lives, the incidence varying with disease severity. In compensated cirrhosis, EV develop at an annual rate of 8%, with higher rates in decompensated cirrhosis.

• #20 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #21 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. […] The most important predictor of variceal hemorrhage is the size of varices, with the highest risk of first hemorrhage occurring in patients with large varices (15% per year). […] Other important predictors of hemorrhage are decompensated cirrhosis (Child-Pugh B/C) and the endoscopic finding of red wale marks.

• #22 Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes

  https://atm.amegroups.org/article/view/28320/html

  Esophageal variceal bleeding remains a common reason for hospitalization in the United States. The main objective of this study was to analyze demographic variations and outcomes in hospitalizations related to esophageal varices (EV) in the US. In 2001, there were 19,167 hospitalizations with discharge diagnoses of EV with and without bleeding compared to 45,578 in 2011 (P0.001). There was a 138% increase in the number of total EV hospitalizations, a 221% increase in hospitalizations with EV without hemorrhage, and a 7% increase in hospitalizations for patients with EV and hemorrhage. The overall in-hospital mortality rate was 3.4% for patients with EV without hemorrhage and 8.7% for patients with EV with hemorrhage (P=0.0003). The number of hospitalizations for patients with asymptomatic EV increased significantly between 2001 to 2011, with only a small concurrent increase in the number of hospitalizations for patients with esophageal variceal bleeding.

• #23 Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes

  https://atm.amegroups.org/article/view/28320/html

  The EV hospitalization rate more than doubled between 2001 and 2011, increasing from 515 to 1,181 per million U.S. population per year (P0.001). Over the same period, the rate of hospitalization for EV without hemorrhage increased from 326 to 990 per million U.S. population per year, an increase of 203%. The rate of hospitalization for EV with hemorrhage increased from 189 to 191 per million U.S. population per year, an increase of 1.2%. The number of hospitalizations for EV with hemorrhage increased only 7% over the decade, from 7,036 hospitalizations in 2001 to 7,451 hospitalizations in 2011. […] Our study reports important findings associated with EV-related hospitalizations over an 11-year period in the U.S. There was a significant increase in the total number of EV-related hospitalizations over the study period. However, the increase in the number of cases of EV with hemorrhage was much lower than the increase in the number of cases of EV without hemorrhage. We postulate that this may be due to improved surveillance of patients at risk for having EV. Current guidelines recommend the performance of esophagogastroduodenoscopy every 2-3 years in patients without a prior history of EV and every 1-2 years in patients with small varices. It is possible that the implementation of these recommendations in practice is leading to: (I) increased diagnosis of patients with EV; (II) increased use of prophylactic strategies to prevent bleeding, like beta blocker therapy and endoscopic variceal ligation.

• #24 Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes

  https://atm.amegroups.org/article/view/28320/html

  The EV hospitalization rate more than doubled between 2001 and 2011, increasing from 515 to 1,181 per million U.S. population per year (P0.001). Over the same period, the rate of hospitalization for EV without hemorrhage increased from 326 to 990 per million U.S. population per year, an increase of 203%. The rate of hospitalization for EV with hemorrhage increased from 189 to 191 per million U.S. population per year, an increase of 1.2%. The number of hospitalizations for EV with hemorrhage increased only 7% over the decade, from 7,036 hospitalizations in 2001 to 7,451 hospitalizations in 2011. […] Our study reports important findings associated with EV-related hospitalizations over an 11-year period in the U.S. There was a significant increase in the total number of EV-related hospitalizations over the study period. However, the increase in the number of cases of EV with hemorrhage was much lower than the increase in the number of cases of EV without hemorrhage. We postulate that this may be due to improved surveillance of patients at risk for having EV. Current guidelines recommend the performance of esophagogastroduodenoscopy every 2-3 years in patients without a prior history of EV and every 1-2 years in patients with small varices. It is possible that the implementation of these recommendations in practice is leading to: (I) increased diagnosis of patients with EV; (II) increased use of prophylactic strategies to prevent bleeding, like beta blocker therapy and endoscopic variceal ligation.

• #25 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #26 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #27 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  Patients with cirrhosis who develop portal hypertension (ie, increased pressure within the portal venous system) are at risk for complications, including bleeding from esophageal varices. […] The rationale for screening for esophageal varices is to identify patients at risk for bleeding from esophageal varices so as to prevent bleeding and improve survival in such patients. […] Screening for esophageal varices is indicated for patients with CSPH and includes the following groups: All patients with decompensated cirrhosis (ie, patients with cirrhosis and at least one complication) […] For patients with compensated cirrhosis, LSM ≤20 kPa, and platelet count >150,000/microL, we do not routinely screen for varices because studies suggest that such patients are unlikely to have varices at risk for bleeding.

• #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 compensated advanced chronic liver disease (ACLD; due to viruses, alcohol, and/or nonobese [BMI < 30 kg/m2] nonalcoholic steatohepatitis) and clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] > 10mmHg and/or liver stiffness by transient elastography > 25 kPa) should receive, if no contraindications, nonselective beta blocker (NSBB) therapy (preferably carvedilol) to prevent the development of variceal bleeding. Strong recommendation, moderate quality evidence. […] ESGE recommends that in those patients unable to receive NSBB therapy with a screening upper gastrointestinal (GI) endoscopy that demonstrates high risk esophageal varices, endoscopic band ligation (EBL) is the endoscopic prophylactic treatment of choice. EBL should be repeated every 2–4 weeks until variceal eradication is achieved. Thereafter, surveillance EGD should be performed every 3–6 months in the first year following eradication. Strong recommendation, moderate quality evidence. […] ESGE recommends that patients who have undergone EBL for acute EVH should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices (secondary prophylaxis). Strong recommendation, moderate quality evidence.

• #29 Diagnosis and Management of Esophagogastric Varices

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

  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 1–2 years. […] 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). […] 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 × 10^9/L. […] Patients who are not candidates for screening endoscopy can be monitored with yearly TE and platelet counts.

• #30 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  Patients with cirrhosis who develop portal hypertension (ie, increased pressure within the portal venous system) are at risk for complications, including bleeding from esophageal varices. […] The rationale for screening for esophageal varices is to identify patients at risk for bleeding from esophageal varices so as to prevent bleeding and improve survival in such patients. […] Screening for esophageal varices is indicated for patients with CSPH and includes the following groups: All patients with decompensated cirrhosis (ie, patients with cirrhosis and at least one complication) […] For patients with compensated cirrhosis, LSM ≤20 kPa, and platelet count >150,000/microL, we do not routinely screen for varices because studies suggest that such patients are unlikely to have varices at risk for bleeding.

• #31 Diagnosis and Management of Esophagogastric Varices

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

  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. […] 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).

• #32 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/3

  Due to its invasive nature, direct measurement of hepatic venous pressure gradient is not widely used in the United States to diagnose clinically significant portal hypertension. […] The 2023 AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis advises using noninvasive markers, including platelet counts and liver stiffness (determined by transient elastography), to determine the likelihood of clinically significant portal hypertension. […] In addition, persons with compensated cirrhosis who have liver stiffness measurements less than 20 kPa and platelet counts greater than 150,000/mm3 (Baveno VI criteria) are at low risk (less than 5%) of having high-risk varices, and do not need screening endoscopy. […] The hepatic venous pressure gradient predicts the risk of developing varices and overall prognosis.

• #33 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Screening endoscopy for gastroesophageal varices is indicated in select patients with cirrhosis to identify varices at a high-risk of variceal hemorrhage (HRV). Patients with very low probability of having HRV can be identified non-invasively and endoscopy can be avoided in 20-30%. Intervals for endoscopic surveillance depend on stage (compensated vs decompensated), ongoing liver injury, and if small varices were found on prior endoscopy. In general, endoscopy should be repeated every 1-3 years in compensated patients, every year in decompensated patients. Endoscopic surveillance in addition to NSBB is indicated for all patients who had variceal bleeding, with the exception of patients with functional TIPS.

• #34 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  Due to its invasive nature, direct measurement of hepatic venous pressure gradient is not widely used in the United States to diagnose clinically significant portal hypertension. […] The hepatic venous pressure gradient predicts the risk of developing varices and overall prognosis. […] The 2023 AASLD Practice Guidance also recommended carvedilol (12.5 mg/day) as the preferred nonselective beta-blocker of choice. […] Patients with clinically significant portal hypertension and contraindications to nonselective beta-blockers should undergo screening esophagogastroduodenoscopy (EGD) to evaluate for the presence of gastroesophageal varices. […] If esophageal varices are found, they should be classified into one of two grades: small (less than or equal to 5 mm) or medium/large (greater than 5 mm).

• #35 Screening for esophageal varices in cirrhotic patients – Non-invasive methods | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-avance-resumen-screening-for-esophageal-varices-in-S1665268119319313

  Screening for esophageal varices in cirrhotic patients Non-invasive methods […] Variceal bleeding is a dramatic complication of cirrhosis. Primary prophylaxis against variceal bleeding is indicated for patients with high-risk varices. In order for these patients to be identified, endoscopic screening for esophageal varices has been traditionally recommended at the time of the diagnosis of cirrhosis. […] Many non-invasive methods have been investigated regarding screening for EV. […] Until recently, the most studied and promising non-invasive method for screening for EV was platelet count/spleen diameter ratio (PC/SD). […] A systematic review aimed at evaluating liver stiffness, spleen stiffness and LSPS for variceal screening. […] In 2015, a guideline published by EASL and the Asociacin Latinoamericana para el Estudio del Hgado stated that endoscopy could not be replaced by non-invasive methods at that moment. […] Considering all that was reviewed, we see a pressing need for noninvasive methods for variceal screening in cirrhotic patients, but we believe that the available evidence still has relevant limitations.

• #36 Is capsule endoscopy effective for screening and surveillance of esophageal varices in patients with portal hypertension? | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/ncpgasthep1280

  Guidelines for the treatment of portal hypertension recommend that individuals with chronic liver disease undergo endoscopy at diagnosis to screen for esophageal varices, with subsequent periodic surveillance. […] This study demonstrated substantial agreement between ECE and EGD for detecting esophageal varices; however, EGD was superior overall for the detection of esophageal varices and, therefore, remains the gold standard diagnostic procedure in this setting.

• #37 Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

  https://www.wjgnet.com/1007-9327/full/v14/i28/4480.htm

  Given our results for capsule endoscopy, we are uncertain if its routine use can replace EGD at this time as a screening tool. It may be useful for those patients who are unable or unwilling to undergo upper endoscopy, but clinicians need to be cognizant of the possibility of a false negative result. At this time, we would recommend use of esophageal capsule endoscopy only in the setting of a clinical trial. […] In conclusion, we feel that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker therapy in early cirrhosis, as well as for determining the specific grade of esophageal varices, PHG, or gastric varices. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices. Clinicians who choose to employ capsule endoscopy as part of their routine clinical practice should be cognizant of the lower accuracy for esophageal variceal screening.

• #38

  https://link.springer.com/article/10.1007/s11894-025-00976-6

  tTo assess the evolving role of endoscopy assessment for esophageal varices in cirrhosis. […] The approach to screening endoscopy for varices has significantly changed in the last 10 years with the refinement of non-diagnostic tests. […] Non-invasive diagnostic methods have reduced the need of upper endoscopies for variceal screening in patients with compensated cirrhosis, focusing primarily on those with ambiguous risk assessments or contraindications to non-selective beta-blockers (NSBBs). In contrast, decompensated cirrhosis patients require more frequent endoscopic evaluations due to their heightened risk of complications and the potential benefit of combination therapy (NSBBs+variceal ligation). […] Emerging applications of artificial intelligence (AI) can assist in patient triage and the interpretation of endoscopic findings, potentially improving care. Further research is essential to validate these technologies within clinical practice and optimize their integration into patient management strategies.

• #39 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Esophageal varices are the most common type of gastrointestinal varices, and their prevalence in Child-Pugh class A is 42.7%, around 70.7% in class B, and 75.5% in class C. The bleeding risk for small varices and large varices is around 5% and 15% per year respectively. Early mortality rate (6 wk) is approximately 20% in esophageal varices after index bleeding. […] All patients who are newly diagnosed with cirrhosis should be screened for esophageal varices. Patients with compensated cirrhosis without varices in the absence of ongoing liver injury, endoscopy should be done every three years. Those who have compensated cirrhosis without varices, but have an ongoing liver injury (alcohol abuse, hepatitis C) and/or other cofactor diseases (alcohol/obesity) screening endoscopy should be repeated every two years.

• #40 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Esophageal varices are the most common type of gastrointestinal varices, and their prevalence in Child-Pugh class A is 42.7%, around 70.7% in class B, and 75.5% in class C. The bleeding risk for small varices and large varices is around 5% and 15% per year respectively. Early mortality rate (6 wk) is approximately 20% in esophageal varices after index bleeding. […] All patients who are newly diagnosed with cirrhosis should be screened for esophageal varices. Patients with compensated cirrhosis without varices in the absence of ongoing liver injury, endoscopy should be done every three years. Those who have compensated cirrhosis without varices, but have an ongoing liver injury (alcohol abuse, hepatitis C) and/or other cofactor diseases (alcohol/obesity) screening endoscopy should be repeated every two years.

• #41 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Patients with small varices without ongoing liver injury or cofactor disease endoscopy is recommended every two years, and every year if either ongoing liver injury or cofactor disease is present. Patients with medium and large size varices should be started on nonselective beta-blockers or considered for EVL. If the patient is on nonselective beta blockers, no further surveillance endoscopy is needed.

• #42 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Patients with small varices without ongoing liver injury or cofactor disease endoscopy is recommended every two years, and every year if either ongoing liver injury or cofactor disease is present. Patients with medium and large size varices should be started on nonselective beta-blockers or considered for EVL. If the patient is on nonselective beta blockers, no further surveillance endoscopy is needed.

• #43 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #44 UK guidelines on the management of variceal haemorrhage in cirrhotic patients | Gut

  https://gut.bmj.com/content/64/11/1680

  We recommend all patients with cirrhosis should be endoscoped at the time of diagnosis (level 1a, grade A). There is no indication to repeat endoscopy in patients receiving NSBB. […] If at the time of first endoscopy no varices are seen, we suggest that patients with cirrhosis should be endoscoped at 2-3 year intervals (level 2a, grade B). […] If grade I varices are diagnosed, we suggest that patients should be endoscoped at yearly intervals (level 2a, grade B). […] If grade I varices and red signs or grade 2-3 varices are diagnosed, we recommend that patients have primary prophylaxis irrespective of the severity of the liver disease (level 1a, grade A). […] We suggest that TIPSS is used for patients who rebleed despite combined VBL and NSBB therapy (or when monotherapy with VBL or NSBB is used owing to intolerance or contraindications to combination therapy), and in selected cases owing to patient choice. PTFE-covered stents are recommended (level 1a, grade A).

• #45 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Patients with small varices without ongoing liver injury or cofactor disease endoscopy is recommended every two years, and every year if either ongoing liver injury or cofactor disease is present. Patients with medium and large size varices should be started on nonselective beta-blockers or considered for EVL. If the patient is on nonselective beta blockers, no further surveillance endoscopy is needed.

• #46 UK guidelines on the management of variceal haemorrhage in cirrhotic patients | Gut

  https://gut.bmj.com/content/64/11/1680

  We recommend all patients with cirrhosis should be endoscoped at the time of diagnosis (level 1a, grade A). There is no indication to repeat endoscopy in patients receiving NSBB. […] If at the time of first endoscopy no varices are seen, we suggest that patients with cirrhosis should be endoscoped at 2-3 year intervals (level 2a, grade B). […] If grade I varices are diagnosed, we suggest that patients should be endoscoped at yearly intervals (level 2a, grade B). […] If grade I varices and red signs or grade 2-3 varices are diagnosed, we recommend that patients have primary prophylaxis irrespective of the severity of the liver disease (level 1a, grade A). […] We suggest that TIPSS is used for patients who rebleed despite combined VBL and NSBB therapy (or when monotherapy with VBL or NSBB is used owing to intolerance or contraindications to combination therapy), and in selected cases owing to patient choice. PTFE-covered stents are recommended (level 1a, grade A).

• #47 Diagnosis and Management of Esophagogastric Varices

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

  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. […] 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).

• #48 Diagnosis and Management of Esophagogastric Varices

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

  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 1–2 years. […] 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). […] 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 × 10^9/L. […] Patients who are not candidates for screening endoscopy can be monitored with yearly TE and platelet counts.

• #49

  https://journals.lww.com/ajg/fulltext/2022/10002/s510_a_clinical_dilemma__surveillance_of_barrett_s.510.aspx

  The diagnosis and management of non-dysplastic, dysplastic, and neoplastic Barretts esophagus (BE) can be complicated by the presence of esophageal varices (EV). Due to the bleeding risk associated with esophageal varices, biopsies of suspected BE can be challenging to obtain. As a result, patients with both varices and BE may not receive adequate surveillance of their Barretts esophagus and may be at an increased risk for esophageal adenocarcinoma. […] Only 5 (41.7%) of the 12 patients with EV and BE received adequate surveillance. […] In summary, this small study of 12 patients with BE and EV suggests that endoscopic surveillance may not be prioritized in the setting of varices. […] This study highlights the importance and difficulty in providing adequate endoscopic surveillance in patients with BE and EV.

• #50

  https://journals.lww.com/ajg/fulltext/2022/10002/s510_a_clinical_dilemma__surveillance_of_barrett_s.510.aspx

  The diagnosis and management of non-dysplastic, dysplastic, and neoplastic Barretts esophagus (BE) can be complicated by the presence of esophageal varices (EV). Due to the bleeding risk associated with esophageal varices, biopsies of suspected BE can be challenging to obtain. As a result, patients with both varices and BE may not receive adequate surveillance of their Barretts esophagus and may be at an increased risk for esophageal adenocarcinoma. […] Only 5 (41.7%) of the 12 patients with EV and BE received adequate surveillance. […] In summary, this small study of 12 patients with BE and EV suggests that endoscopic surveillance may not be prioritized in the setting of varices. […] This study highlights the importance and difficulty in providing adequate endoscopic surveillance in patients with BE and EV.

• #51 To Band or Not To Band? Esophageal Varices in the Pediatric Population | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/band-or-not-band-esophageal-varices-pediatric

  Extrahepatic portal vein obstruction and biliary atresia are the most common causes of portal hypertension in the pediatric population. […] The overall incidence and mortality of variceal bleeding in children is lower than in adults. […] Primary prophylaxis of esophageal varices with band ligation is not a standard practice. […] Band ligation is the preferred method of endoscopic management of esophageal varices that have bled or have high likelihood of bleeding. Sclerotherapy is used for smaller children (typically 10 kg). […] Surgical shunts are typically recommended for refractory symptoms of portal hypertension. Meso Rex bypass shunts are typically preferred for pediatric patients with EHPVO.

• #52 To Band or Not To Band? Esophageal Varices in the Pediatric Population | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/band-or-not-band-esophageal-varices-pediatric

  Extrahepatic portal vein obstruction and biliary atresia are the most common causes of portal hypertension in the pediatric population. […] The overall incidence and mortality of variceal bleeding in children is lower than in adults. […] Primary prophylaxis of esophageal varices with band ligation is not a standard practice. […] Band ligation is the preferred method of endoscopic management of esophageal varices that have bled or have high likelihood of bleeding. Sclerotherapy is used for smaller children (typically 10 kg). […] Surgical shunts are typically recommended for refractory symptoms of portal hypertension. Meso Rex bypass shunts are typically preferred for pediatric patients with EHPVO.

• #53 Diagnosis and Management of Esophagogastric Varices

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

  Primary prophylaxis is especially important in compensated patients with CSPH and/or EV or GV because they are at high risk of decompensating. […] 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. […] In patients who re-bleed despite traditional NSBBs or carvedilol and EVL, a transjugular intrahepatic portosystemic shunt is the treatment of choice.

• #54 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  The 2023 AASLD guidance recommends primary prophylaxis with either (1) a nonselective beta-blocker (including carvedilol) or (2) endoscopic variceal ligation, with preference given to nonselective beta-blockers due to benefits beyond preventing variceal bleeding. […] Nonselective beta-blockers can reduce the risk of rebleeding by about 40% and improve overall survival by 20%. […] Endoscopic variceal ligation therapy is superior to sclerotherapy for secondary prophylaxis and decreases the rebleeding rate to around 32%. […] The combination of a nonselective beta-blocker and endoscopic therapy can be used as secondary variceal hemorrhage prophylaxis for gastroesophageal varices.

• #55 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  For patients with cirrhosis but without high-risk esophageal varices on screening upper endoscopy, surveillance intervals are informed by the endoscopic findings and activity of the patient’s liver disease. […] General measures to prevent the first episode of variceal bleeding include: Manage underlying liver disease – Patients with cirrhosis are evaluated for interventions that will slow or reverse the progression of liver disease. […] For patients with cirrhosis and esophageal varices at high risk for bleeding, we recommend prophylaxis with a nonselective beta blocker rather than no pharmacologic intervention because evidence suggests that beta blockers resulted in lower risk of mortality. […] For patients who have a contraindication to or cannot tolerate beta blockers, we suggest endoscopic variceal ligation (EVL) rather than no intervention because evidence suggests that EVL resulted in lower risk of variceal bleeding and mortality.

• #56 Diagnosis and Management of Esophagogastric Varices

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

  Primary prophylaxis is especially important in compensated patients with CSPH and/or EV or GV because they are at high risk of decompensating. […] 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. […] In patients who re-bleed despite traditional NSBBs or carvedilol and EVL, a transjugular intrahepatic portosystemic shunt is the treatment of choice.

• #57 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  The 2023 AASLD guidance recommends primary prophylaxis with either (1) a nonselective beta-blocker (including carvedilol) or (2) endoscopic variceal ligation, with preference given to nonselective beta-blockers due to benefits beyond preventing variceal bleeding. […] Nonselective beta-blockers can reduce the risk of rebleeding by about 40% and improve overall survival by 20%. […] Endoscopic variceal ligation therapy is superior to sclerotherapy for secondary prophylaxis and decreases the rebleeding rate to around 32%. […] The combination of a nonselective beta-blocker and endoscopic therapy can be used as secondary variceal hemorrhage prophylaxis for gastroesophageal varices.

• #58 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  The 2023 AASLD guidance recommends primary prophylaxis with either (1) a nonselective beta-blocker (including carvedilol) or (2) endoscopic variceal ligation, with preference given to nonselective beta-blockers due to benefits beyond preventing variceal bleeding. […] Nonselective beta-blockers can reduce the risk of rebleeding by about 40% and improve overall survival by 20%. […] Endoscopic variceal ligation therapy is superior to sclerotherapy for secondary prophylaxis and decreases the rebleeding rate to around 32%. […] The combination of a nonselective beta-blocker and endoscopic therapy can be used as secondary variceal hemorrhage prophylaxis for gastroesophageal varices.

• #59 Combination Therapy as Primary Prophylaxis for High-Risk Esophageal Varices – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/schoenfeld_dec2024/

  The overall incidence of first variceal bleed was significantly lower in the combination therapy group vs non-selective beta blocker monotherapy or VBL monotherapy: 11.8% vs 33.6% vs 25.5%, respectively, P < 0.002. [...] The 2024 guidelines from the American Association for the Study of Liver Diseases (AASLD) recommend “if high-risk varices are detected, non-selective beta blockers or endoscopic band ligation are recommended; preference is given to non-selective beta blockers (including carvedilol) because of benefits beyond prevention of variceal hemorrhage.” [...] Comparative RCTs of non-selective beta blockers and VBL for primary prophylaxis have produced mixed results, with some studies demonstrating non-inferiority and others suggesting superiority for VBL, although there is an increased risk of major adverse events with VBL.

• #60 Diagnosis and Management of Esophagogastric Varices

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

  Primary prophylaxis is especially important in compensated patients with CSPH and/or EV or GV because they are at high risk of decompensating. […] 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. […] In patients who re-bleed despite traditional NSBBs or carvedilol and EVL, a transjugular intrahepatic portosystemic shunt is the treatment of choice.

• #61 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 compensated advanced chronic liver disease (ACLD; due to viruses, alcohol, and/or nonobese [BMI < 30 kg/m2] nonalcoholic steatohepatitis) and clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] > 10mmHg and/or liver stiffness by transient elastography > 25 kPa) should receive, if no contraindications, nonselective beta blocker (NSBB) therapy (preferably carvedilol) to prevent the development of variceal bleeding. Strong recommendation, moderate quality evidence. […] ESGE recommends that in those patients unable to receive NSBB therapy with a screening upper gastrointestinal (GI) endoscopy that demonstrates high risk esophageal varices, endoscopic band ligation (EBL) is the endoscopic prophylactic treatment of choice. EBL should be repeated every 2–4 weeks until variceal eradication is achieved. Thereafter, surveillance EGD should be performed every 3–6 months in the first year following eradication. Strong recommendation, moderate quality evidence. […] ESGE recommends that patients who have undergone EBL for acute EVH should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices (secondary prophylaxis). Strong recommendation, moderate quality evidence.

• #62 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 compensated advanced chronic liver disease (ACLD; due to viruses, alcohol, and/or nonobese [BMI < 30 kg/m2] nonalcoholic steatohepatitis) and clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] > 10mmHg and/or liver stiffness by transient elastography > 25 kPa) should receive, if no contraindications, nonselective beta blocker (NSBB) therapy (preferably carvedilol) to prevent the development of variceal bleeding. Strong recommendation, moderate quality evidence. […] ESGE recommends that in those patients unable to receive NSBB therapy with a screening upper gastrointestinal (GI) endoscopy that demonstrates high risk esophageal varices, endoscopic band ligation (EBL) is the endoscopic prophylactic treatment of choice. EBL should be repeated every 2–4 weeks until variceal eradication is achieved. Thereafter, surveillance EGD should be performed every 3–6 months in the first year following eradication. Strong recommendation, moderate quality evidence. […] ESGE recommends that patients who have undergone EBL for acute EVH should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices (secondary prophylaxis). Strong recommendation, moderate quality evidence.

• #63

  https://journals.lww.com/ajg/fulltext/2018/10001/adherence_to_screening,_primary_prophylaxis,_and.964.aspx

  There are no current acceptable rates of esophageal variceal screening, surveillance, and utilization of primary prophylaxis(PP) in cirrhotics. […] We analyzed our screening, surveillance, and PP practices for esophageal varices(EV) at a VA Medical Center(VAMC), as well as rates of esophageal variceal bleeding (EVB). […] Screening EGD was performed in 119 (79%) patients after an initial encounter with GI. […] Ninetysix (81%) patients were screened within one year. […] The surveillance rate with EGD was 71% in Childs A, 70% in Childs B, and 67% in Childs C cirrhosis. […] We identified strengths and weaknesses in screening and surveillance practices at a VAMC. […] While EV screening rates have varied between 46-62% in patients referred for liver transplant, we found better rates of screening within one year. […] Nevertheless, only 58% of patients eligible to receive PP received either NSBB or EVL.

• #64 QI Project Aims to Reduce Variability in Varices Care

  https://www.gastroendonews.com/Hepatology-in-Focus/Article/05-21/QI-Project-Aims-to-Reduce-Variability-in-Varices-Care/63422

  Adherence to published surveillance guidelines for esophageal varices in patients with cirrhosis can be bolstered by the introduction of an automated prescriptive template, researchers have found. […] A survey performed at the time revealed that suboptimal adherence in documenting surveillance recommendations was largely the product of variability in provider practices, as well as a low satisfaction rate with the existing endoscopy template among clinicians. […] In the period following implementation of the automated endoscopy template (June 2019-March 2020), 223 EGDs were performed. Over that nine-month period, adherence in documenting guideline recommendations rose steadily in each quarter, from 69% in the pre-intervention period to 74% (64/86 EGDs), 80% (71/89 EGDs) and 94% (45/48 EGDs), the researchers reported. […] Adherence is particularly difficult given the range of society recommendations that may exist. Guidelines also vary according to the clinical situation, Zubarik said.

• #65

  https://link.springer.com/article/10.1007/s11894-025-00976-6

  tTo assess the evolving role of endoscopy assessment for esophageal varices in cirrhosis. […] The approach to screening endoscopy for varices has significantly changed in the last 10 years with the refinement of non-diagnostic tests. […] Non-invasive diagnostic methods have reduced the need of upper endoscopies for variceal screening in patients with compensated cirrhosis, focusing primarily on those with ambiguous risk assessments or contraindications to non-selective beta-blockers (NSBBs). In contrast, decompensated cirrhosis patients require more frequent endoscopic evaluations due to their heightened risk of complications and the potential benefit of combination therapy (NSBBs+variceal ligation). […] Emerging applications of artificial intelligence (AI) can assist in patient triage and the interpretation of endoscopic findings, potentially improving care. Further research is essential to validate these technologies within clinical practice and optimize their integration into patient management strategies.

• #66 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. […] The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. […] Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #67 Esophageal Varices | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21350

  Incidence: At diagnosis, 30% of cirrhotic patients have varices which increase to 90% in 10 years. The 1-year rate of first variceal bleeding is 5% for small varices, 15% for large varices. […] Portal hypertension is common in chronic liver disease (CLD) in children. […] Prevalence: It is more common in males than in females. Fifty percent of patients with esophageal varices will experience bleeding at some point. Variceal bleeding has a 10% to 20% mortality rate in the 6 weeks following the episode. […] In the West, the two common causes of portal hypertension are alcohol and viral hepatitis. In Asia and Africa, the most common causes of portal hypertension include schistosomiasis and hepatitis B/C.

• #68 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #69 Update on the management of gastrointestinal varices

  https://www.wjgnet.com/2150-5349/full/v10/i1/1.htm

  Esophageal varices are the most common type of gastrointestinal varices, and their prevalence in Child-Pugh class A is 42.7%, around 70.7% in class B, and 75.5% in class C. The bleeding risk for small varices and large varices is around 5% and 15% per year respectively. Early mortality rate (6 wk) is approximately 20% in esophageal varices after index bleeding. […] All patients who are newly diagnosed with cirrhosis should be screened for esophageal varices. Patients with compensated cirrhosis without varices in the absence of ongoing liver injury, endoscopy should be done every three years. Those who have compensated cirrhosis without varices, but have an ongoing liver injury (alcohol abuse, hepatitis C) and/or other cofactor diseases (alcohol/obesity) screening endoscopy should be repeated every two years.

• #70 SCREENING AND SURVEILLANCE OF VARICES IN PATIENTS WITH CIRRHOSIS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139072/

  Gastro-esophageal varices (GEV) and variceal hemorrhage (VH) are clinical milestones in the natural history of cirrhosis, as they are closely related to the severity of portal hypertension and define specific stages in disease progression. The goal of screening and surveillance of varices is to identify patients with GEV at a high risk of bleeding, so that prevention strategies can be implemented. Screening endoscopy is recommended in patients with cirrhosis to determine if they have varices at high risk of bleeding which will require treatment with either non-selective betablockers (NSBB) or endoscopic variceal ligation (EVL) in order to prevent VH, in accordance with the most recent American Association for the Study of Liver Diseases guidance. The risk of first VH is 5-15% per year, highest in patients with large varices, severe liver disease (Child class B/C), or with varices having endoscopic red wale marks (areas of thinning of the variceal wall). In compensated cirrhosis, the prevalence of any GEV is 30%-40%, and only a minority (10%-20%) have high-risk varices (HRV) requiring treatment. Surveillance endoscopy to detect HRV in patients with compensated cirrhosis is recommended every 1-3 years, or when decompensation occurs. For decompensated patients, surveillance endoscopy is recommended every year. Once HRV are found and variceal bleeding prevention strategies are in place, there is no need for further surveillance endoscopy.

• #71 Core Concepts – Screening for Varices and Prevention of Bleeding – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/varices-screening-prevention-bleeding/core-concept/all

  The 2023 AASLD guidance recommends primary prophylaxis with either (1) a nonselective beta-blocker (including carvedilol) or (2) endoscopic variceal ligation, with preference given to nonselective beta-blockers due to benefits beyond preventing variceal bleeding. […] Nonselective beta-blockers can reduce the risk of rebleeding by about 40% and improve overall survival by 20%. […] Endoscopic variceal ligation therapy is superior to sclerotherapy for secondary prophylaxis and decreases the rebleeding rate to around 32%. […] The combination of a nonselective beta-blocker and endoscopic therapy can be used as secondary variceal hemorrhage prophylaxis for gastroesophageal varices.

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