Hepatitis C

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


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 varices	Repeat endoscopy in 3 years (sooner if decompensation occurs)
Small varices	In a CTP B/C patient or varices with red signs	Nonselective 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
Small varices	In a CTP A patient, without red signs	Nonselective ß-blockers optional If no ß-blockers are given, repeat endoscopy in 2 years (sooner if decompensation occurs)	Same as above
Medium/large varices	All patients independent of CTP class	Nonselective ß-blockers (propranolol, nadolol) or^a	Same as above
Medium/large varices	All patients independent of CTP class	Endoscopic variceal ligation	Ligate every 1-2 weeks until variceal obliteration First surveillance endoscopy 1-3 months after obliteration, then every 6-12 months indefinitely