How often should patients with a history of variceal bleeding be monitored for recurrence of varices?

UK clinical guidelines primarily focus on the initial detection of oesophageal varices in patients with cirrhosis and the primary prevention of bleeding, rather than specifying a routine monitoring frequency for the recurrence of varices after a bleeding event and subsequent treatment NICE NG50,NICE CKS. For individuals with cirrhosis, an upper gastrointestinal endoscopy is offered to detect oesophageal varices unless they are planning to take carvedilol or propranolol for primary prevention of decompensation NICE NG50. If no varices are found during an initial endoscopy and the patient is not taking carvedilol or propranolol, surveillance endoscopy is offered every 3 years NICE NG50,NICE CKS. If medium or large varices are detected, treatment options for primary prevention of bleeding include carvedilol or propranolol, or endoscopic variceal band ligation NICE NG50. For acute variceal bleeding, band ligation is used NICE CG141.

Regarding monitoring for recurrence after variceal eradication, such as by band ligation, a prospective randomized trial investigated endoscopic follow-up intervals. This study compared endoscopic follow-up at 3 months versus 6 months after oesophageal variceal eradication by band ligation in patients with cirrhosis (Debernardi Venon et al. 2014).