Endoscopic diagnosis and therapy of gastro-esophageal varices

Endoscopic examination has a primary role in diagnosis and elective or emergency treatment of esophago-gastric varices. NIEC score has proved to be particulary useful to predict bleeding incidence within a year in a cirrhotic patient presenting esophageal varices. For gastric varices, at present, there is not any international agreement for an endoscopic classification defining haemorrhagic risk. Emergency sclerotherapy is particularly effective in controlling variceal bleeding (over 95% of success). Then, when available, it must be performed as soon as possible. Non controlled non randomized trials have shown that Cyanoacrylate (Histoacryl) intravariceal injections are very useful in treatment of large esophageal varices and gastric ones, both in immediate and delayed emergency. Anyway the technique is complex and presents some complications for instruments and accessories. Esophageal varices band ligation is a new method that probably is going to replace sclerotherapy. It has a lower incidence of complications and shortens the times needed for eradication. For these reasons this technique should be evaluated in RCTs versus pharmacological treatment in prophylaxis of first bleeding.