Liver Disease pp 195-208 | Cite as

Esophageal Varices

  • Sofia Simona Jakab
  • Guadalupe Garcia-TsaoEmail author


Variceal hemorrhage is one of the complications of cirrhosis that defines progression to the stage of decompensated cirrhosis, with a mortality as high as 40%, depending on the severity of liver disease. Therefore, it is essential to identify patients with cirrhosis at a high risk of variceal bleeding, so that prevention strategies can be implemented. In this chapter, we describe a case of a patient recently diagnosed with cirrhosis. We discuss current recommendations on screening/surveillance for esophageal varices, strategies for primary and secondary prophylaxis of esophageal variceal hemorrhage (EVH), as well as treatment options and outcomes of EVH.


Cirrhosis Esophageal variceal hemorrhage (EVH) Prophylactic therapy Endoscopic variceal ligation (EVL) Upper endoscopy Non-selective beta blockers (NSBB) Transjugular intrahepatic portosystemic shunt (TIPS) Resuscitation 

Further Reading

  1. 1.
    Abraldes JG, Bureau C, Stefanescu H, et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: the “anticipate” study. Hepatology. 2016;64:2173–84.CrossRefGoogle Scholar
  2. 2.
    Albillos A, Zamora J, Martínez J, et al. Stratifying risk in the prevention of recurrent variceal hemorrhage: results of an individual patient meta-analysis. Hepatology. 2017;66(4):1219–31.CrossRefGoogle Scholar
  3. 3.
    Conejo I, Guardascione MA, Tandon P, et al. Multicenter external validation of risk stratification criteria for patients with variceal bleeding. Clin Gastroenterol Hepatol. 2018;16(1):132–9.CrossRefGoogle Scholar
  4. 4.
    Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.CrossRefGoogle Scholar
  5. 5.
    Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310–35.CrossRefGoogle Scholar
  6. 6.
    Merkel C, Zoli M, Siringo S, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol. 2000;95(10):2915–20.CrossRefGoogle Scholar
  7. 7.
    The European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–60.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA
  2. 2.Section of Digestive Diseases, VA CT Healthcare SystemWest HavenUSA

Personalised recommendations