From the Research
The recommended surveillance interval for gastric varices in the UK is typically every 3-6 months following initial diagnosis and treatment, though this may vary based on individual patient factors. For patients with high-risk gastric varices who have undergone endoscopic therapy, follow-up endoscopy is generally advised at 3 months initially, then every 6 months if stable, as suggested by recent guidelines 1. Patients with low-risk gastric varices may be monitored less frequently, approximately every 6-12 months. This surveillance schedule allows for timely detection of variceal recurrence or progression, enabling prompt intervention to prevent bleeding complications. The frequency of surveillance should be adjusted based on the patient's liver disease severity, previous bleeding history, size of varices, presence of red signs, and response to previous treatments, as highlighted in a study on the management of gastric varices 2. Non-selective beta-blockers such as propranolol or carvedilol are often prescribed alongside endoscopic surveillance as part of the management strategy, as recommended by international guidelines 3. Regular clinical assessment should accompany endoscopic surveillance, including evaluation of liver function, portal hypertension status, and assessment for hepatic encephalopathy or ascites, as these factors may influence the surveillance approach, as discussed in a review on the diagnosis and management of esophagogastric varices 3.
Some key factors to consider when determining the surveillance interval include:
- Liver disease severity
- Previous bleeding history
- Size of varices
- Presence of red signs
- Response to previous treatments These factors can influence the risk of variceal bleeding and the need for more frequent surveillance, as noted in a study on the endoscopic treatment of gastric varices 4.
In terms of specific surveillance intervals, a study on the management of gastric varices suggested that patients with high-risk varices should be monitored every 3-6 months, while those with low-risk varices may be monitored less frequently, approximately every 6-12 months 2. However, the most recent and highest quality study on this topic, published in 2022, emphasizes the importance of a multidisciplinary approach to managing patients with gastric varices, taking into account patient characteristics and local expertise 1.
Overall, the key to effective surveillance of gastric varices is to tailor the approach to the individual patient's needs and risk factors, while also considering the latest evidence and guidelines, as discussed in a review on the management of patients with gastric varices 1.