For patients diagnosed with cirrhosis, the recommended screening protocol for oesophageal varices typically involves an upper gastrointestinal endoscopy NICE NG50,NICE CKS. This initial endoscopy is offered unless the patient is planning to take carvedilol or propranolol for the primary prevention of decompensation NICE NG50.
If an initial endoscopy has been performed and no oesophageal varices were found, and the patient is not taking carvedilol or propranolol, surveillance using upper gastrointestinal endoscopy is offered every 3 years NICE NG50,NICE CKS. However, if a person is already taking non-selective beta-blocker therapy, such as carvedilol or propranolol, for primary prevention of decompensation or to prevent bleeding from medium or large varices, further variceal surveillance via endoscopy is generally not needed NICE CKS.
Should medium or large varices be detected during an upper gastrointestinal endoscopy, simultaneous endoscopic variceal band ligation may be considered NICE NG50. Alternatively, carvedilol or propranolol can be offered, with endoscopic variceal band ligation as an option if beta-blockers are not tolerated, contraindicated, or if the patient's circumstances prevent regular tablet intake NICE NG50.
Beyond traditional endoscopy, research is exploring other methods for screening. For instance, elastography-based screening for oesophageal varices in patients with advanced chronic liver disease has been investigated Paternostro et al. 2019.
Key References
- NG50 - Cirrhosis in over 16s: assessment and management
- CKS - Cirrhosis
- NG231 - Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management
- (D'Antiga, 2012): Medical management of esophageal varices and portal hypertension in children.
- (Paternostro et al., 2019): Elastography-based screening for esophageal varices in patients with advanced chronic liver disease.
- (Bruni et al., 2025): Advances in Endo-Hepatology: The Role of Endoscopic Ultrasound in the Management of Portal Hypertension.