ASGE guideline: the role of endoscopy in the management of variceal hemorrhage, updated July 2005

This is one of a series of staleinents discussing the utilizalion of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. A previous guideline related to this topic (Gastrointest Endosc 2002;56..618-20) was publisbed in 2002. Since that time, new information has become available which requires an update of this statement and its recommendations. In preparing this update, a MEDLINE literature search was performed, and additional references were obtained from The bibliographies of the identified articles and from The recommendations of expert consultants. When inadequate data existed from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data a car. Clinical consideration may justify a course of action at variance from these recommendations. Variceal bleeding is a common and serious complication of portal hypertension. Mortality after the index hemorrhage in patients with cirrhosis has been reported to be as high as 50%, with a 30% mortality associated with subsequent bleeding episodes.(1)More recent data suggest an overall threefold decrease in in-hospital mortality over the last 2 decades with the increasing use of vasoactive drugs, endoscopy, and antibiotic prophylaxis.(2) The optimal management of patients with variceal bleeding requires a multidisciplinary approach by a team that includes endoscopists, interventional radiologists, and surgeons. The purpose of this guideline is to provide an updated, practical strategy for the specific use of encloscopy in screening for esophageal varices, prevention of the initial bleeding, and the management of patients with variceal hemorrhage.