Patient Monitoring

• Close monitoring of vital signs if actively bleeding
• Endoscopic variceal ligation, repeated every 1–4 weeks until varices eradicated
• All patients with cirrhosis should undergo endoscopy to document the presence of varices and risk of hemorrhage (1)[B].
• If transjugular intrahepatic portasystemic shunt or other portacaval shunt, repeat endoscopy only if clinically bleeding
• If transjugular intrahepatic portasystemic shunt present, follow-up as recommended by radiologist; usually Doppler sonogram each 6 months

Patient Education

• Appropriate to cirrhosis
• National Digestive Information Clearinghouse, 2 Information Way, Bethesda, MD 20892 or American Liver Foundation, 1425 Pompton Way, Cedar Grove, NJ 07009

Prognosis

• Depends heavily on ability to treat or reverse underlying condition
• In those with cirrhosis, 1 year survival for those who are alive 2 weeks after variceal bleed is ~50%.

Complications

• Bleeding
• Gastric or other uncommon varices may occur following successful eradication of esophageal varices.
• Esophageal varices can recur after obliteration.