U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients

Dhiraj Tripathi, Adrian J Stanley, Peter C Hayes, David Patch, Charles Millson, Homoyon Mehrzad, Andrew Austin, James W Ferguson, Simon P Olliff, Mark Hudson, John M Christie, Clinical Services and Standards Committee of the British Society of Gastroenterology, Dhiraj Tripathi, Adrian J Stanley, Peter C Hayes, David Patch, Charles Millson, Homoyon Mehrzad, Andrew Austin, James W Ferguson, Simon P Olliff, Mark Hudson, John M Christie, Clinical Services and Standards Committee of the British Society of Gastroenterology

Abstract

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool.The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions.

Keywords: BLEEDING; CIRRHOSIS; GASTROINTESTINAL HAEMORRHAGE; OESOPHAGEAL VARICES; PORTAL HYPERTENSION.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
(A) Grade I oesophageal varices. These collapse to inflation of the oesophagus with air. (B) Grade II oesophageal varices. These are varices between grades 1 and 3. (C) Grade III oesophageal varices. These are large enough to occlude the lumen.
Figure 2
Figure 2
Algorithm for surveillance of varices and primary prophylaxis in cirrhosis. *– If there is clear evidence of disease progression this interval can be modified by clinician. Endoscopy should also be offered at time of decompensation.
Figure 3
Figure 3
Algorithm for the management of acute variceal bleeding. TIPSS, transjugular intrahepatic portosystemic stent shunt.

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Source: PubMed

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