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

John Gasdal Karstensen, Alanna Ebigbo, Purnima Bhat, Mario Dinis-Ribeiro, Ian Gralnek, Claire Guy, Olivier Le Moine, Peter Vilmann, Giulio Antonelli, Uche Ijoma, Gideon Anigbo

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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.
    Original languageEnglish
    Pages (from-to)E990-E997
    JournalEndoscopy International Open (EIO)
    Volume8
    Issue number7
    DOIs
    Publication statusPublished - 2020

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