This protocol applies to patients with liver cirrhosis who have high-risk gastro-oesophageal varices and no history of variceal bleeding. The goal is to prevent a first haemorrhagic event with prophylactic intervention initiated at detection.
High-risk varices are defined as: small varices with red signs, medium or large varices regardless of Child-Pugh classification, or small varices in Child-Pugh C patients. Primary prophylaxis must be started upon detection because of the elevated risk of variceal haemorrhage in these groups.
Non-selective beta-blockers form the cornerstone of management in this setting, with additional interventional options available depending on the clinical profile. The full evidence-based regimen — including which approach applies to which patient group — is detailed in the structured protocol.
DOI: 10.1016/j.jhep.2018.03.024
Primary prophylaxis must be initiated upon detection of "high-risk varices" (i.e. small varices with red signs, medium or large varices irrespective of Child-Pugh classification or small varices in Child-Pugh C patients) because of increased risk of VH (I;1).
Patients with small varices with red wale marks or Child-Pugh C should be treated with NSBBs (III;1).
Patients with medium-large varices should be treated with either NSBBs or EBL (I;1).
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