COMMENTARY

The Clinical Management of Gastroesophageal Varices

Rowen K. Zetterman, MD

Disclosures

January 20, 2012

In This Article

Summary

Esophageal varices develop in 5%-10% of patients with cirrhosis annually. Esophageal varices are more likely to bleed than gastric varices, although gastric variceal hemorrhage may be more severe. All patients with cirrhosis should be screened for gastroesophageal varices, and patients with medium-to-large varices should receive prophylaxis with beta-blockers to reduce the risk for bleeding. In patients who are intolerant to or who have contraindications to beta-blockers, band ligation of esophageal varices is effective in reducing the risk for esophageal hemorrhage. Once variceal hemorrhage occurs, band ligation of esophageal varices or cyanoacrylate injection of gastric varices can be used. For poorly controlled patients with continuing bleeding, placement of a TIPS or surgical shunt may be required.

Key Points

  1. All patients with compensated cirrhosis should be screened for gastroesophageal varices every 2 years.

  2. Upper endoscopy is the screening method of choice.

  3. Patients with decompensated cirrhosis should have more frequent endoscopic screening.

  4. Patients with esophageal varices > 5 mm in diameter should receive noncardioselective beta-blocker prophylaxis with propranolol, nadolol, or carvedilol.

  5. For those intolerant to or with contraindications for beta-blockers, obliteration of esophageal varices with band ligation is an alternative method of prophylaxis.

Comments

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