Review Article
Prevention and Management of Gastroesophageal Varices in Cirrhosis
Table 1
Primary prophylaxis and surveillance.
| Surveillance/prophylaxis modalities | Indications | Dose | Goal |
| Endoscopic surveillance | Low-risk* small varices (not on nonselective BB**) | Every 2 years and annually with liver decompensation | Surveillance for progression into higher-risk lesions needing medical or endoscopic prophylaxis | Nadolol | High-risk*** small varices and medium-large varices Optional: low-risk small varices | Start: 40 mg qd | Titrate to heart rate: 55 beats/minute or maximally tolerated dose | Propranolol | High-risk small varices and medium-large varices Optional: low-risk small varices | Start: 10 mg bid | Titrate to heart rate: 55 beats/minute or maximally tolerated dose | EVBL | Medium to large varices | Every 2–4 weeks | Until variceal obliteration |
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*Low-risk: Child A cirrhosis and no red wale marks, ** beta-blocker, ***high-risk: Child B or C cirrhosis and/or presence of red wale marks.
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