Surveillance for gastro-oesophageal varices in patients with cirrhosis

Endoscopic variceal surveillance is not recommended in patients with compensated cirrhosis who either:

• are already prescribed a nonselective beta blocker to prevent decompensation (see Prevention of decompensation in patients with compensated cirrhosis), or
• have a platelet count of more than 150 × 10⁹/L and a liver stiffness of less than 20 kPa (measured by vibration-controlled transient elastography [VCTE]). People in this group have a low risk of haemorrhage and endoscopic surveillance is not required¹; a full blood count and liver stiffness measurement should be performed annually.

For all other patients with cirrhosis, the recommended interval between endoscopies in patients who do not have varices, or who have varices that do not need treatment, is as follows:

• compensated cirrhosis and no varices—repeat endoscopy every 2 to 3 years. If the cause of cirrhosis is not controlled (eg ongoing hazardous alcohol use, untreated chronic viral hepatitis) repeat endoscopy every 2 years
• compensated cirrhosis and small varices—repeat endoscopy every 1 to 2 years. If the cause of cirrhosis is not controlled (eg ongoing hazardous alcohol use, untreated chronic viral hepatitis), repeat endoscopy annually
• decompensated cirrhosis—repeat endoscopy annually.

For recommendations about endoscopic surveillance in patients with cirrhosis who are receiving primary or secondary prophylaxis for variceal bleeding (with a nonselective beta blocker, variceal band ligation or a combination of these), see:

• Primary prevention of bleeding gastro-oesophageal varices
• Secondary prevention of bleeding gastro-oesophageal varices.