Esophageal varices in pregnancy: Strategies to optimize maternal and fetal outcomes

Table 4 Comparative summary of guideline recommendations on esophageal varices in pregnancy

Guideline	Timing of endoscopy	Primary prophylaxis (NSBB vs EVL)
AASLD (2023)	Preconception; if not done, perform in the second trimester for high-risk cases	Recommends NSBB for small varices with high-risk features. For medium to large varices, either NSBB or EVL may be used. EVL preferred if NSBB contraindicated or not tolerated
EASL (2022)	Not specified	Both NSBB and EVL are first-line options. NSBB preferred as they improve long-term outcomes (reduce ascites, decompensation, and mortality) compared with EVL
Baveno VII (2022)	Does not specify timing in pregnancy	NSBB preferred in all patients with CSPH irrespective of variceal size; EVL only if NSBB contraindicated or not tolerated
ASGE (2021)	Second trimester preferred for safety of endoscopy	Not specified
BSGE (2021)	Second trimester preferred	Not specified
INASL (2019)	Not specified	Small high-risk varices: NSBB prophylaxis. Medium/Large varices: NSBB or EVL can be used

AASLD: American Association for the Study of Liver Diseases; EASL: European Association for the Study of the Liver; Baveno VII: Baveno Consensus Workshop on Portal Hypertension; ASGE: American Society for Gastrointestinal Endoscopy; BSGE: British Society of Gastroenterology; INASL: Indian National Association for the Study of the Liver; NSBB: Non-selective beta-blocker; EVL: Endoscopic variceal ligation; CSPH: Clinically significant portal hypertension.