A team from the University of Alabama at Birmingham, USA, determined whether screening recommendations for varices are being followed in patients presenting for evaluation of orthotopic liver transplantation.
125 patients referred for liver transplantation were evaluated.
Data regarding demographics, clinical information, and relevant time intervals (diagnosis of cirrhosis to screening, screening to initial variceal bleeding, variceal bleeding to referral, diagnosis of cirrhosis to referral) was obtained. In addition, information on screening strategies used, and implementation of primary or secondary prophylaxis was collated.
The investigators found that 46% of patients presenting for evaluation of liver transplantation had screening endoscopy or radiological studies to detect the presence of varices (primary prophylaxis).
|Variceal screening was performed in only 46% of potential liver transplantation patients.|
|American Journal of Gastroenterology|
In contrast, secondary prophylaxis (therapy after the initial episode of bleeding to prevent recurrence) was performed in all patients with a prior history of variceal hemorrhage.
Screening for varices displayed no regional differences.
Researcher M. R. Arguedas concluded on behalf of the team, "In our cohort, screening for varices is not being consistently performed, thus delaying the timely implementation of primary prophylaxis.
"Therefore, the adherence to currently available practice guidelines and the education of physicians to implement screening in this patient population is an important goal."
In an accompanying editorial, Dr Naga Chalasani writes, "The findings by Arguedas et al. need to be confirmed and extended to explore the reasons for non-adherence to published guidelines, and more research needs to be done to establish the cost-effectiveness of endoscopic variceal screening.
"Meanwhile, it is essential that all of us who care for patients with cirrhosis adhere to the published guidelines for primary prophylaxis of variceal bleeding, beginning with endoscopic screening for their detection."