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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

Authors

  • 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
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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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