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Current Hepatology Reports

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Open Access 01-12-2018 | Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

Small Esophageal Varices in Patients with Cirrhosis—Should We Treat Them?

Authors: Thomas Reiberger, Theresa Bucsics, Rafael Paternostro, Nikolaus Pfisterer, Florian Riedl, Mattias Mandorfer

Published in: Current Hepatology Reports | Issue 4/2018

Abstract

Purpose of Review

The natural history and classification systems of small varices (≤ 5 mm in diameter) in cirrhotic patients with portal hypertension are summarized. Studies that assessed the course of and therapeutic intervention for small varices are discussed.

Recent Findings

Current non-invasive methods show suboptimal sensitivity to detect small varices in patients with cirrhosis. Next to etiological therapy, hepatic venous pressure gradient (HVPG)-guided non-selective betablocker or carvedilol treatment has shown to impact on natural history of small varices.

Summary

The main therapeutic focus in cirrhotic patients with small varices is the cure of the underlying etiology. The optimal management of small varices should include measurement of HVPG. A pharmacological decrease in HVPG by non-selective betablocker therapy of ≥ 10% reduces the risk of progression to large varices, first variceal bleeding, and hepatic decompensation. If HVPG is not available, we would recommend carvedilol 12.5 mg q.d. for treatment of small varices in compensated patients without severe ascites. Only if small esophageal varices (EV) are not treated or in hemodynamic non-responders, follow-up endoscopies should be performed in 1–2 years of intervals considering the activity of liver disease or if hepatic decompensation occurs.

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Title: Small Esophageal Varices in Patients with Cirrhosis—Should We Treat Them?
Authors: Thomas Reiberger
Theresa Bucsics
Rafael Paternostro
Nikolaus Pfisterer
Florian Riedl
Mattias Mandorfer
Publication date: 01-12-2018
Publisher: Springer US
Published in: Current Hepatology Reports / Issue 4/2018
Electronic ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-018-0420-z

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