Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 37: Which Asymptomatic Patients With Cirrhosis Should Undergo An Upper Endoscopy To Determine Whether They Have Esophageal Varices? (continued)

Nagib Toubia, MD; Adil Habib, MD; Douglas M. Heuman, MD

In our practice, all patients with cirrhosis are offered endoscopy to assess for presence and size of varices. Patients with bridging fibrosis on biopsy may also merit screening endoscopy if they exhibit thrombocytopenia, splenomegaly, or other signs of portal hypertension. We do this for 3 key reasons: (1) esophageal variceal bleeding can occur at any point after development of portal hypertension and carries significant risk; (2) at the present time only endoscopy can reliably detect varices and predict the likelihood of variceal bleeding; and (3) available treatments can prevent variceal…