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Endoscopic Management of Esophageal Varices and Variceal Hemorrhage

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Diagnostic and Therapeutic Procedures in Gastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

A varix (pl. varices) is an abnormally dilated vessel with a tortuous course.Esophageal varices are portosystemic collaterals. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the submucosa of the lower esophagus. Acute variceal hemorrhage is a medical emergency. Approximately 40% of patients with cirrhosis are found to have esophageal varices on endoscopic evaluation, and approximately one-third of patients will experience variceal hemorrhage. Historically, mortality after index hemorrhage in patient with cirrhosis has been reported up to 50%, with a 30% mortality rate associated with subsequent bleeding episodes. More recent data suggest improvement in mortality with improvement in management, however still associated with 20% mortality risk at 6 weeks. The risk of variceal hemorrhage is increased in large varices and in those that demonstrate stigmata of bleeding, as well as in patients with high Child–Pugh scores, high variceal pressure, and previous episodes of variceal hemorrhage and in patients who continue to ingest alcohol. The size of the varix is the single most important predictor of bleeding risk. Primary prophylaxis of varices should be considered in varices larger than 5 mm. Esophageal varices are graded according to size and appearance. Grade 1 (F1) varices are small, are straight, and flatten with distention of the esophagus. Grade 2 (F2) varices are tortuous, comprise less than one-third of the lumen, and do not disappear with distention. Grade 3 (F3) varices are tortuous and comprise greater than one-third of the lumen.

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Authors and Affiliations

  1. Advanced Endoscopy, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Sidhartha S. Tulachan

  2. Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, 15th Street, Augusta, GA, 30912, USA

    Jigar Bhagatwala

  3. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, AD-2226, 1120, 15th Street, Augusta, GA, 30912, USA

    Subbaramiah Sridhar

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  1. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Subbaramiah Sridhar

  2. Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA

    George Y. Wu

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Tulachan, S.S., Bhagatwala, J., Sridhar, S. (2018). Endoscopic Management of Esophageal Varices and Variceal Hemorrhage. In: Sridhar, S., Wu, G. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62993-3_14

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