3-5 Slides

For Students By Students

Primary Prophylaxis
for Esophageal varices
in Cirrhosis
Which of the following patients needs
primary prophylaxis for esophageal varices?
Picture A

Primary prophylaxis means; patient has

esophageal varices but never had bleeding from
varices
1. Small varices on endoscopy
2. No varices seen during screening endoscopy Picture B

3. Child A cirrhosis with varices seen on Picture A

4. Varices seen on Picture B
Which of the following patient needs primary
prophylaxis for esophageal varices? Picture A

Primary prophylaxis means; patient has esophageal

varices but never had bleeding from varices
1. Small varices on endoscopy
2. No varices seen during screening endoscopy
3. Child A cirrhosis with varices seen on Picture A Picture A
4. Varices seen on Picture B (Patient has medium
size varices with possible red spots cherry red
spots on varices which suggests impending
rupture, yellow arrow)
 Few tips for Primary
Prophylaxis (PP)
Indications of Primary Prophylaxis
Small varices with red signs or Child B or
C cirrhosis
Endoscopic Grades of esophageal varices
Medium or large varices

Most important points for PP of variceal bleed

1. B blocker (BB) or Endoscopic variceal ligation
(EVL) can be considered.
2. Most will prefer BB initially and EVL after if BB
are not tolerated or failed.
3. Target HR on BB: 55-60 or 25% reduction of HR
from baseline
4. Nadolol and Propranolol, are the only drugs
recommended for prophylaxis against a first
variceal hemorrhage. However, the safety of
nonselective beta blockers in patients with
refractory ascites or spontaneous bacterial
peritonitis has been called into question.