Monitoring
Follow-up recommendations vary depending on the size of esophageal varices, and whether the patients have ever had esophageal variceal bleeding.[5][37][38]
Compensated cirrhosis without varices on screening endoscopy:
Patients with compensated cirrhosis without clinically significant portal hypertension should undergo regular (6-monthly) ultrasound imaging to screen for hepatocellular carcinoma and portal vein thrombosis; special attention should be paid to imaging evidence indicating the development of clinically significant portal hypertension, and annual liver stiffness measurement can identify patients who would benefit from further endoscopic screening.[5]
Patients with compensated cirrhosis with clinically significant portal hypertension who have a contraindication or intolerance to beta-blockers require surveillance endoscopy every 2 years if injury to the liver is ongoing, or every 3 years if the etiologic agent has been eliminated.[5] Treatment with nonselective beta-blockers obviates the need for further screening endoscopy.
Compensated cirrhosis with varices on screening endoscopy:
Patients with compensated cirrhosis with varices on endoscopy with contraindication or intolerance to beta-blockers should have endoscopy repeated every year (with ongoing liver injury) or every 2 years (if liver injury is quiescent, e.g., after viral elimination, alcohol abstinence).[5] Treatment with nonselective beta-blockers obviates the need for further screening endoscopy.
Following variceal eradication by banding ligation:
Periodic endoscopy should be repeated every 6-12 months.[5]
Following successful TIPS during the acute bleeding episode:
Patency of TIPS should be assessed by Doppler ultrasound at 1 week, 3 months, 6 months, and every 6 months thereafter.[56]
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