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What criteria should I use to determine when to refer a patient with oesophageal varices for endoscopic intervention?
Answer
Guideline-Aligned (High Confidence)
Generated by iatroX. Developer: Dr Kola Tytler MBBS CertHE MBA MRCGP (General Practitioner).
Last reviewed: 17 August 2025
Referral for Endoscopic Intervention in Oesophageal Varices
- For Acute Bleeding: Patients with suspected variceal bleeding should be referred for endoscopy immediately after resuscitation 1. Endoscopic band ligation is the recommended treatment for upper gastrointestinal bleeding from oesophageal varices 1. If bleeding from oesophageal varices is not controlled by band ligation, transjugular intrahepatic portosystemic shunts (TIPS) should be considered 1.
- For Primary Prevention of Bleeding: For people with medium or large oesophageal varices, endoscopic variceal band ligation may be offered for the primary prevention of bleeding 3,4. This intervention is considered if carvedilol or propranolol (non-selective beta-blockers) are not tolerated, are contraindicated, or if the person cannot take tablets regularly due to their circumstances 4. Surveillance endoscopy may be needed at diagnosis and every 3 years to detect varices, unless the person is already taking carvedilol or propranolol for primary prevention 3.
Key References
- CG141 - Acute upper gastrointestinal bleeding in over 16s: management
- CG184 - Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
- CKS - Cirrhosis
- NG50 - Cirrhosis in over 16s: assessment and management
- CKS - Dyspepsia - proven GORD
- CKS - Dyspepsia - pregnancy-associated
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