Advances in portal hypertension management: Evolution of the Baveno guidelines

Table 2 Prevention of first variceal bleeding

Baveno version (reference) - year of publication	NSBBs indications	Carvedilol	EBL
I[8], 1992	Recommended for high-risk varices, but not for small varices	Not mentioned	Not recommended
II[16], 1996	NSBBs confirmed as primary therapy for large varices	Not mentioned	Potentially valuable but role unclear
III[17], 2000	First-line treatment for large varices, but not indicated for small varices	Not mentioned	Alternative to NSBBs for large varices, but role uncertain
IV[18], 2005	Expanded to include small varices with high-risk features	First mentioned as a possible alternative to traditional NSBBs	Recommended for patients intolerant to NSBBs, but long-term benefits uncertain
V[19], 2010	Further expanded to all small varices, even without high-risk signs	Suggested to have potential advantages over propranolol/nadolol	Recommended for medium/Large varices
VI[20], 2015	Confirmed for all small varices to prevent progression and bleeding	More effective than traditional NSBBs in reducing HVPG	Recommended for medium/Large varices
VII[1], 20221	Recommended for CSPH to prevent decompensation	Preferred for compensated cirrhosis	Recommended for high-risk varices in NSBB-intolerant patients

¹This recommendation should be considered in addition to the Baveno VI.

CSPH: Clinically significant portal hypertension; EBL: Endoscopic band ligation; HVPG: Hepatic venous pressure gradient; NSBBs: Non-selective beta-blockers.