Definitions, methodology and therapeutic strategies in portal hypertension

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

“…Upper gastrointestinal endoscopy (UGIE) should be performed once the diagnosis of cirrhosis is established and is the gold standard for the diagnosis of varices [2,[5][6][7]. For definitions relative to prophylactic treatment of gastroesophageal varices, primary prophylaxis relates to offering treatment to prevent the first variceal bleed in patients who have never had any previous variceal hemorrhage [5].…”

“…For definitions relative to prophylactic treatment of gastroesophageal varices, primary prophylaxis relates to offering treatment to prevent the first variceal bleed in patients who have never had any previous variceal hemorrhage [5]. Factors associated with the risk of bleeding from varices include size and wall thickness, the presence of endoscopic stigmata such as red signs (an area where the variceal wall is thin, and therefore weakened), the severity of the liver disease, and the portal pressure [8][9][10][11][12].…”

“…In most prophylactic studies, ''highrisk'' varices have been defined as those that are either moderate or large in size with the presence of red signs (red wale marks, defined as longitudinal dilated venules resembling whip marks on the variceal surface; cherry-red spots, defined as red, discrete, flat spots on varices; and hematocystic spots, defined as red, discrete, raised spots). It was felt necessary to define variceal size as either small or large, with large varices being those greater than 5 mm [5]. The group appreciated that the proportion of varices that are at high risk of bleeding, such as small varices but presence of red signs, does not fall within this definition.…”

“…Screening for varices UGIE is considered the gold standard for the diagnosis of varices. Currently, the predictive accuracy of noninvasive methods such as fibrotest, spleen size, portal vein diameter, and transient elastography to reliably detect varices in the esophagus is unsatisfactory [5,14]. Modalities such as platelet count, platelet count to spleen diameter ratio, and fibroscan could have a good predictive value but need confirmation by further studies.…”

“…Its role for screening varices needs further studies. UGIE should be part of the routine clinical practice once the diagnosis of cirrhosis is made [1,2,[5][6][7]. Studies have reported that UGIE is reliable and has shown good agreement between observers for the size of varices and the presence of red signs [17,18].…”