Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Abstract

This guideline has been approved by the American Association for the Study of Liver Diseases and the American College of Gastroenterology and represents the position of both associations. PreambleThese recommendations provide a data-supported approach to the management of patients with varices and variceal hemorrhage.They are based on the following: (1) formal review and analysis of the recently published world literature on the topic (Medline search); (2) several consensus conferences among experts; (3) the American College of Physicians' Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; (4) guideline policies, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and the American Gastroenterological Association's Policy Statement on the Use of Medical Practice Guidelines 2 ; and (5) the authors' years of experience caring for patients with cirrhosis and varices.Intended for use by healthcare providers, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care.As with other practice guidelines, this guideline is not intended to replace clinical judgment but rather to provide general guidelines applicable to the majority of patients.They are intended to be flexible, in contrast to standards of care, which are inflexible policies designed to be followed in every case.Specific recommendations are based on relevant published information.To more fully characterize the quality of evidence supporting recommendations, the Practice Guidelines Committee of the AASLD requires a class (reflecting benefit versus risk) and level (assessing strength or certainty) of evidence to be assigned and reported with each recommendation (Table 1, adapted from the American College of Cardiology and the American Heart Association Practice Guidelines 3,4 ).When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts.Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear.Clinical considerations may justify a course of action that differs from these recommendations.These recommendations are fully endorsed by the American Association for the Study of Liver Diseases and the American College of Gastroenterology.