Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis

Table 1 Summary on primary prevention of esophageal variceal bleeding

		Management	Goal of treatment
Cirrhosis		Diagnostic endoscopy for the presence of varices
No varices		Endoscopic surveillance	Surveillance for development of varices (every 2-3 yr in compensated cirrhosis/yearly in cases of decompensation)
Small varices	Low risk of bleeding	Endoscopic surveillance Or NSBBs	Surveillance for progression of varices (every 1-2 yr in compensated cirrhosis/yearly in cases of decompensation)
	Increased risk of bleeding1	NSBBs	Decrease in HVPG of at least 20% from baseline or ≤ to 12 mmHg or resting heart rate of about 55 to 60 beats/min
Medium-large varices		NSBBs Or EBL2	NSBBs: Decrease in HVPG of at least 20% from baseline or ≤ to 12 mmHg or resting heart rate of about 55 to 60 beats/min EBL: Variceal obliteration

¹Child-Pugh B/C cirrhosis or red signs at initial endoscopy;

²The choice of treatment should be based on local resources and expertise, patient preference and characteristics, side effects, and contra-indications. NSBBs: Non-selective beta blockers; EBL: Endoscopic band ligation; HVPG: Hepatic venous pressure gradient.