Screening

Esophago-gastro-duodenoscopy (EGD) is considered the most accurate method to identify varices.[5][6][33][34]

EGD is, however, invasive and associated with risk. Identifying patients with a low probability of having high-risk gastroesophageal varices can help to avoid screening EGD (endoscopy). Noninvasive or minimally invasive techniques to assess portal hypertension have been proposed and are well established.[32]

Liver and/or spleen stiffness measurements, or composite scores, can identify patients with clinically significant portal hypertension. Appropriate cutoff values for these parameters may be precise in excluding patients from endoscopy with a negative likelihood ratio of less than 0.10.[29][30][31][43]

Expanded-Baveno VI criteria have been validated in several patient cohorts (with compensated advanced chronic liver disease) and suggest that endoscopy may only be indicated if liver stiffness measurement (LSM) ≥25 kPa and platelet count ≤110 x 10⁹ cells/L.[35] This prediction rule would potentially avoid 40% of endoscopies, with an associated risk of missing 0.6% (95% CI 0.3 to 1.4%) of varices requiring treatment among patients with compensated advanced chronic liver disease.[35]

Patients with an LSM <20 kPa and platelet count >150,000/mm³ have a very low probability (<5%) of having high‐risk varices; therefore, EGD can be safely avoided.[5]

Patients who do not satisfy these criteria should undergo screening endoscopy when the diagnosis of cirrhosis is made.

Video capsule endoscopy is a safe and well-tolerated alternative for patients who are not candidates for EGD, or if EGD is not available.[39] However, sensitivity of capsule endoscopy is not sufficient to replace EGD as an initial exploration.[39][40]

Use of this content is subject to our disclaimer