Algorithm for the Primary Prophylaxis of Esophageal Variceal Hemorrhage in Patients with Cirrhosis - Flowchart
Algorithm for the Primary Prophylaxis of Esophageal Variceal Hemorrhage in Patients with Cirrhosis - Flowchart Esophageal Varices Esophageal Varices
«Flowchart»

Upper endoscopy

Upper endoscopy

Upper endoscopy

No varices

No varices

No varices

Large esophageal varices

Large esophageal varices

Large esophageal varices

Small esophageal varices

Small esophageal varices

Small esophageal varices

Consider HVPG measurement

Consider HVPG measurement

Consider HVPG measurement

Perform EVL

Perform EVL

Perform EVL

Consider HVPG remeasurement

Consider HVPG remeasurement

Consider HVPG remeasurement

End

End

End

Nonselective β-adrenergic blocking agent

Nonselective β-adrenergic blocking agent

Nonselective β-adrenergic blocking agent

β

Repeat endoscopy in 1-2 yr

Repeat endoscopy in 1-2 yr

Repeat endoscopy in 1-2 yr

EVL, Endoscopic variceal ligation.

EVL, Endoscopic variceal ligation.

EVL, Endoscopic variceal ligation.

EVL

Repeat endoscopy in 2-3 yr

Repeat endoscopy in 2-3 yr

Repeat endoscopy in 2-3 yr

Contraindication to β-adrenergic blocking agents
Intolerance to β-adrenergic blocking agents
Target HVPG not reached
Patient preference

Contraindication to β-adrenergic blocking agents
Intolerance to β-adrenergic blocking agents
Target HVPG not reached
Patient preference

β
β

Contraindication to β-adrenergic blocking agents β

Nonselective β-adrenergic blocking agent

Nonselective β-adrenergic blocking agent

β Nonselective β-adrenergic blocking agent β