Screening and Surveillance of Varices in Patients With Cirrhosis

Abstract

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. Variceal hemorrhage is a life-threatening complication of cirrhosis and is one of the clinical complications that defines cirrhosis decompensation. 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. There have been significant updates in the management of GEV over the last years, particularly in the use of non-invasive methods to assess the degree of portal hypertension and the likelihood of having GEV. This paper is focused on esophageal varices with or without extension along the lesser curvature (type 1 or GOV1), as special considerations are required for the management of cardiofundal varices (GOV2 - esophageal varices extending into the fundus, or IGV1 - isolated gastric varices in the fundus) or isolated gastric varices type 2 (IGV2 – gastric varices elsewhere in the stomach, not in the fundus).

Figure 1

Screening and surveillance of varices in patients with cirrhosis. cACLD, compensated advanced chronic liver disease; LS, liver stiffness; plts, platelet count (10³/mL); CSPH, clinically significant portal hypertension; EGD, esophagogastroduodenoscopy; HRV, high-risk varices; NSBB, non-selective beta-blockers; EVL, endoscopic variceal ligation.