CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(07): E990-E997
DOI: 10.1055/a-1187-1154
Guideline

Endoscopic treatment of variceal upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline

John Gásdal Karstensen
 1   Hvidovre Hospital – Gastro Unit, Hvidovre, Denmark
 2   University of Copenhagen – Department of Clinical Medicine, Copenhagen, Denmark
,
Alanna Ebigbo
 3   Central Clinic of Augsburg – Gastroenterology, Augsburg, Germany
,
Purnima Bhat
 4   ANU Medical School/Canberra Hospital – Gastroenterology, Garran, Australia
,
Mario Dinis-Ribeiro
 5   Instituto Português de Oncologia – Gastrenterologia, Porto, Portugal
 6   Porto Faculty of Medicine – Biostatistics and Medical Informatics, Porto, Portugal
,
Ian Gralnek
 7   Emek Medical Center – Gastroenterology and Hepatology, Afula, Northern Israel
,
Claire Guy
 8   European Society of Gastrointestinal Endoscopy – Munich, Germany
,
Olivier Le Moine
 9   Hopital Erasme, Université Libre de Bruxelles – Department of Gastroenterology
Brussels, Belgium
,
Peter Vilmann
10   Copenhagen University Hospital Herlev – Gastro Unit, Herlev, Denmark
,
Giulio Antonelli
11   Azienda Ospedaliera Sant'Andrea – Sapienza University of Rome, Digestive and Liver Disease Unit, Rome, Italy
,
Uche Ijoma
12   University of Nigeria Teaching Hospital – Department of Gastroenterology, Enugu, Nigeria
,
Gideon Anigbo
13   Enugu State University Teaching Hospital – Department of Medicine, Enugu, Nigeria
,
Mary Afiheni
14   Kwame Nkrumah University of Science and Technology – Department of Medicine, Kumasi, Ghana
,
Babatunde Duduyemi
15   Kwame Nkrumah University of Science and Technology – Department of Pathology, Kusami, Ghana
,
Hailemichael Desalegn
16   St. Paul’s Hospital Millenium Medical College – Department of Internal Medicine, Addis Ababa, Addis Ababa, Ethiopia
,
Roberto De Franchis
17   University of Milan, IRCCS Maggiore Policlinico Hospital – Department of Internal Medicine Gastroenterology and Digestive Endoscopy Service, Milan, Italy
,
Thierry Ponchon
18   Edouard Herriot Hospital – Hepatogastroenterology, Lyon, France
,
Cesare Hassan
19   ONRM Hospital – Gastro, Rome, Italy
,
Lars Aabakken
20   Dept of transplantation medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway and Faculty of Medicine, University of Oslo, Norway
› Author Affiliations

Introduction

Patients with variceal gastrointestinal bleeding are encountered daily in endoscopic departments around the world. Risk factors include infectious diseases such as hepatitis B and C virus and schistosomiasis, as well as alcohol consumption and metabolic syndrome with development of nonalcoholic fatty liver disease [1]. Globally, prevalence and incidence of chronic liver disease and cirrhosis varies markedly between countries [2]. High-quality epidemiological data from the majority of African countries are lacking; nevertheless, development of cirrhosis and related consequences are a major burden for public health systems in the continent [2] [3] [4]. In Africa, mortality from cirrhosis is estimated at 12.9 to 24.2 per 100,000 person-years range and prevalence of hepatitis B virus is among the highest in the world at 6,100 per 100,000 inhabitants [5] [6].

The latest update of the Baveno guideline describes in detail how to prevent and manage variceal bleeding, as well as how to avoid recurrent bleeding [7]. The majority of recommendations in the guideline are based on high levels of evidence and many years of practice. However, some of the recommendations are resource-sensitive and may be unavailable in low-resource settings due to factors such as extensive costs, lack of sufficient health professional training and logistical limitations.

The European Society of Gastrointestinal Endoscopy (ESGE) has implemented a cascade methodology in a joint effort with the World Endoscopy Organization (WEO), aiming to adapt existing guidelines to make them applicable to resource-limited regions (including some African countries) [8]. Previously, two cascade guidelines have been published focusing on endoscopic management of non-variceal upper gastrointestinal bleeding and upper gastrointestinal obstruction, respectively [8] [9] [10]. This ESGE cascade guideline aims to standardize endoscopic management of patients with variceal gastrointestinal bleeding.



Publication History

Received: 19 May 2020

Accepted: 21 May 2020

Article published online:
01 July 2020

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