Cirrhosis (Variceal Screening) — ESEGH MCQ
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Correct answer: B — Upper endoscopy to screen for varices
Upper gastrointestinal endoscopy is the gold standard and first-line screening test for oesophageal varices in patients with newly diagnosed compensated cirrhosis, according to NICE NG50 and ESGE guidance. This allows both detection of varices and immediate therapeutic intervention (variceal banding ligation for medium/large varices). Option A (CT angiography) has no role in variceal screening despite being able to visualise portal hypertension; it cannot reliably grade oesophageal varices. Option C (MRCP) is for biliary and pancreatic duct imaging, not variceal detection. Option D (capsule endoscopy) is not recommended routinely for initial screening—it lacks therapeutic capability and is inferior to conventional endoscopy for sensitivity and specificity. Option E is incorrect because screening is indicated unless the patient is already on beta-blocker prophylaxis (which he is not). The clinical detail that he is not planning pharmacological prophylaxis clarifies that endoscopy is necessary (recent NICE guidance exempts patients from endoscopy if already on carvedilol/propranolol for decompensation prevention).
Reference: NICE NG50: Cirrhosis in over 16s – assessment and management (amended 2023), https://www.nice.org.uk/guidance/ng50/chapter/recommendations