Monitoring
Follow-up recommendations vary depending on the size of oesophageal varices, and whether the patient has previously had oesophageal variceal bleeding.[5][6][29]
Compensated cirrhosis without varices on screening endoscopy:
The National Institute for Health and Care Excellence (NICE) in the UK recommends surveillance using upper gastrointestinal endoscopy every 3 years for patients with no varices detected on endoscopy.[17]
The British Society of Gastroenterology (BSG) recommends endoscopy at 2- to 3-year intervals for these patients.[5]
Cirrhosis with small varices on screening endoscopy:
The BSG recommends annual endoscopy.[5] If there is clear evidence of disease progression, the BSG recommends modifying the endoscopy intervals according to clinical need.[5]
Following variceal eradication by banding ligation:
Endoscopy should be performed at 3 months after varices have been eliminated, and then every 6 months.[5]
Following successful transjugular intrahepatic portosystemic shunt (TIPS) during the acute bleeding episode:
A Doppler ultrasound is recommended a week after TIPS implantation in patients with prothrombotic conditions (e.g., Budd-Chiari syndrome), and in other patients if TIPS dysfunction is suspected.[55]
Most patients undergoing TIPS have cirrhosis; in these patients, Doppler ultrasound surveillance can be incorporated into routine 6-monthly hepatocellular carcinoma screening, where this is offered.[55]
Routine transjugular venography is not recommended. It should be reserved for cases where stent dysfunction is detected on Doppler ultrasound or is clinically suspected (e.g., recurrent ascites).[55]
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