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Review
. 2023 Mar 8;13(6):1031.
doi: 10.3390/diagnostics13061031.

Diagnosis and Management of Esophagogastric Varices

Socrate Pallio  1 , Giuseppinella Melita  2 , Endrit Shahini  3 , Alessandro Vitello  4 , Emanuele Sinagra  5 , Barbara Lattanzi  6 , Antonio Facciorusso  7 , Daryl Ramai  8 , Marcello Maida  4
Affiliations
Review

Diagnosis and Management of Esophagogastric Varices

Socrate Pallio et al. Diagnostics (Basel). .

Abstract

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. Thus, esophagogastric varices represent a major economic and population health issue. 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. Patients with high-risk varices should receive primary prophylaxis with either nonselective beta-blockers or endoscopic band ligation. In cases of AVB, patients should receive upper endoscopy within 12 h after resuscitation and hemodynamic stability, whereas endoscopy should be performed as soon as possible if patients are unstable. In cases of suspected variceal bleeding, starting vasoactive therapy as soon as possible in combination with endoscopic treatment is recommended. On the other hand, in cases of uncontrolled bleeding, balloon tamponade or self-expandable metal stents can be used as a bridge to more definitive therapy such as transjugular intrahepatic portosystemic shunt. This article aims to offer a comprehensive review of recommendations from international guidelines as well as recent updates on the management of esophagogastric varices.

Keywords: endoscopy; esophageal varices; gastric varices; gastrointestinal bleeding; portal hypertension.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Esophageal varices according to size: F1 (a), F2 (b), F3 (c).
Figure 2
Figure 2
Illustration of different types of gastric varices according to the Sarin classification (GOV: gastroesophageal varices; IGV: isolated gastric varices) [13].
Figure 3
Figure 3
Screening and primary prophylaxis of esophageal varices.
Figure 4
Figure 4
Management of acute esophageal variceal bleeding.
Figure 5
Figure 5
Management of acute gastric variceal bleeding.
See this image and copyright information in PMC

References

    1. Laine L., Yang H., Chang S.C., Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am. J. Gastroenterol. 2012;107:1190–1195. doi: 10.1038/ajg.2012.168. - DOI - PubMed
    1. Stanley A.J., Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019;364:l536. doi: 10.1136/bmj.l536. - DOI - PubMed
    1. Wuerth B.A., Rockey D.C. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig. Dis. Sci. 2018;63:1286–1293. doi: 10.1007/s10620-017-4882-6. - DOI - PubMed
    1. Opio C.K., Rejani L., Kazibwe F., Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afr. Health Sci. 2019;19:3225–3234. doi: 10.4314/ahs.v19i4.46. - DOI - PMC - PubMed
    1. Nusrat S., Khan M.S., Fazili J., Madhoun M.F. Cirrhosis and its complications: Evidence based treatment. World J. Gastroenterol. 2014;20:5442–5460. doi: 10.3748/wjg.v20.i18.5442. - DOI - PMC - PubMed

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