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Management strategy after results of screening endoscopy in patients with cirrhosis

for Health Care Providers

Table 1. Management strategy after results of screening endoscopy in patients with cirrhosis

Back to Cirrhosis Recommendations

BID, twice a day; bpm, beats/min; CTP, Child-Turcotte-Pugh; EGD, esophagogastroduodenoscopy; QD, once daily.

a Choice depends on patient characteristics and preferences, local resources.

No varicesRepeat endoscopy in 3 years (sooner if decompensation occurs)
Small varicesIn a CTP B/C patient or varices with red signsNonselective ß-blockers (propranolol or nadolol)Start propranolol (20mg BID) or nadolol (20mg QD)
Titrate to maximal tolerable dose or a heart rate of 55-60 bpm
No need to repeat EGD
In a CTP A patient, without red signsNonselective ß-blockers optional
If no ß-blockers are given, repeat endoscopy in 2 years (sooner if decompensation occurs)
Same as above
Medium/large varicesAll patients independent of CTP classNonselective ß-blockers (propranolol, nadolol)
ora
Same as above
Endoscopic variceal ligationLigate every 1-2 weeks until variceal obliteration
First surveillance endoscopy 1-3 months after obliteration, then every 6-12 months indefinitely

From Management and Treatment of Patients with Cirrhosis and Portal Hypertension