What are the recommended screening protocols for oesophageal varices in patients with cirrhosis?

For patients diagnosed with cirrhosis, the recommended screening protocol for oesophageal varices typically involves an upper gastrointestinal endoscopy ¹,². This initial endoscopy is offered unless the patient is planning to take carvedilol or propranolol for the primary prevention of decompensation ¹.

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 ¹,². 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 ².

Should medium or large varices be detected during an upper gastrointestinal endoscopy, simultaneous endoscopic variceal band ligation may be considered ¹. 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 ¹.

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).