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Liver Diseases pp 617–626Cite as

Endoscopic and Pharmacological Treatment of Esophageal Varices

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Abstract

Bleeding from gastroesophageal varices (GEV) represents a potentially lethal complication of liver cirrhosis. Currently gastroscopy is the milestone as a screening test for varices and it is routinely offered once the diagnosis of cirrhosis is confirmed; however, non-invasive elastography techniques offer valuable alternatives and may help to discriminate patients at high risk of developing GEVs and first episode of bleeding from low-risk subjects.

Non-selective beta-blockers (NSBBs) and terlipressin represent the most commonly used pharmacological agents for prevention and management of acute bleeding, respectively. However, novel evidence suggest beneficial effects with the use of other molecules such as carvedilol or simvastatin.

Endoscopic band ligation is the most effective endoscopic treatment in the setting of either acute bleeding and primary/secondary prevention and it has nearly completely replaced sclerotherapy in the clinical practice.

Aim of this chapter is to provide an overview on recent improvements and latest developments concerning the pharmacological and endoscopic treatment of esophageal varices, particularly based on the most robust evidence-based findings.

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Authors and Affiliations

  1. Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy

    Antonio Facciorusso, Rosario Vincenzo Buccino & Nicola Muscatiello

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  1. Antonio Facciorusso
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  2. Rosario Vincenzo Buccino
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  3. Nicola Muscatiello
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Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Which statement is true?

    1. (a)

      Non-selective beta-blockers (NSBBs) are less effective than endoscopic variceal band ligation (EVBL) as primary prophylaxis of variceal bleeding.

    2. (b)

      NSBBs are usually prescribed in monotherapy as secondary prophylaxis of variceal bleeding.

    3. (c)

      NSBBs are as effective as EVBL in primary prophylaxis of variceal bleeding.

    4. (d)

      a, b.

  2. 2.

    Which statement is true?

    1. (a)

      According to Baveno VI criteria, screening gastroscopy is indicated in all cirrhotic patients.

    2. (b)

      According to Baveno VI criteria, screening gastroscopy is not indicated in patients with a liver stiffness <20 kPa and with a platelet count >150,000.

    3. (c)

      According to Baveno VI criteria, screening gastroscopy is contraindicated in cirrhotic patients.

    4. (d)

      None of the above.

1.2 Answers

  1. 1.

    Which statement is true?

    1. (a)

      NSBBs lead to similar results as EVBL in primary prophylaxis of variceal bleeding. In the case of small varices NSBBs are usually preferred as EVBL may appear challenging in this subset of patients.

    2. (b)

      Cornerstone of secondary prophylaxis of variceal bleeding is the association of NSBBs and EVBL.

    3. (c)

      Randomized controlled trials and meta-analyses showed that association of NSBBs and EVBL is not superior to NSBBs alone in primary prophylaxis of variceal bleeding-CORRECT.

  2. 2.

    Which statement is true?

    1. (b)

      According to Baveno VI criteria gastroscopy is not indicated in patients with a liver stiffness <20 kPa and with a platelet count >150,000-CORRECT.

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Facciorusso, A., Buccino, R.V., Muscatiello, N. (2020). Endoscopic and Pharmacological Treatment of Esophageal Varices. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_55

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