GuidelineThe role of endoscopy in the management of variceal hemorrhage
Section snippets
Screening for esophageal varices
Effective prophylactic treatments exist for patients with esophageal varices to prevent variceal bleeding.8 There are no reliable methods for predicting which cirrhotic patients will have esophageal varices without endoscopy.9 The most recent American Association for the Study of Liver Disease (AASLD) and Baveno V consensus guidelines suggest that all patients who have been diagnosed with cirrhosis undergo screening endoscopy to assess for esophageal and gastric varices.10, 11 If esophageal
Gastric varices
Gastric varices are most commonly continuations of esophageal varices and extend 2 to 5 cm below the gastroesophageal junction along the lesser curve of the stomach. Isolated gastric varices are most commonly located in the gastric fundus (type 1 isolated gastric varices) and can be seen in patients with cirrhosis and portal hypertension as well as in patients with splenic vein thrombosis (eg, from pancreatic disease) or portal vein thrombosis. Bleeding from gastric varices is typically high
Recommendations
Recommendations regarding screening for esophageal varices:
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We recommend that all patients who have a diagnosis of cirrhosis undergo screening endoscopy to assess for esophageal and gastric varices. ⊕⊕⊕⊕
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In patients with compensated cirrhosis found to have no varices on initial screening endoscopy, we recommend repeat endoscopy every 2 to 3 years, whereas patients with small varices should undergo repeat endoscopy every 1 to 2 years. ⊕⊕⊕⊕
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We recommend yearly upper endoscopy in patients who have
Disclosures
The following authors disclosed financial relationships relevant to this publication: Dr Khashab, consultant to Boston Scientfic; Dr Saltzman, consultant to Cook Endoscopy and Beacon Endoscopy; Dr Hwang, speaker for Novartis, consultant to US Endoscopy, and research grant from Olympus; Dr Chathadi, speaker for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
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Endoscopic Treatment of Esophageal Varices
2022, Clinics in Liver DiseaseCitation Excerpt :Combination therapy with EVL and β-blockers is not recommended for primary prophylaxis because it has not been shown to decrease bleeding risk or mortality and is associated with increased side-effects. PPI usually are used as adjunctive therapy to reduce the risk of ligation-induced ulcers.25 Recommendations for the treatment and prevention of recurrence of AVB are based primarily on consensus conferences and major gastroenterology and hepatology societies, including the Baveno VI consensus workshop19 and the AASLD,6 as well as the ASGE,25 BSG,26 and ESGE.27
Esophageal Stent in Acute Refractory Variceal Bleeding: A Systematic Review and a Meta-Analysis
2024, Journal of Clinical MedicineGuidelines for the Management of Esophagogastric Variceal Bleeding in Cirrhotic Portal Hypertension
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This document is a product of the Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.