The current guidelines for primary prophylaxis of variceal hemorrhage in cirrhotic patients recommend screening for varices with upper endoscopy.
Utilization and outcomes of screening in clinical practice are unknown.
Dr Atif Zaman and colleagues from Oregon determined the use of endoscopic variceal screening in diverse practice settings.
The team of doctors assessed factors associated with the finding of esophageal varices.
|Varices were found in 52% of screened patients|
Endoscopic reports generated by 68 Clinical Outcomes Research Initiative repository were analyzed.
From these reports, the doctors evaluated the use, changes over time, and findings of screening upper endoscopies between 2000 and 2003.
Upper endoscopy was performed in 1688 of 172,854 patients for the purpose of screening for varices.
Overall, the doctors found that there was a linear increase in annual proportion of screening for varices with upper endoscopy.
More upper endoscopy variceal screenings are performed in academic centers than in Veteran's Affairs Medical Centers and community practices.
The doctors found varices in 52% of screened patients.
The team observed varices more often in Child-Pugh class B/C compared with Child-Pugh class A patients.
The team noted that, of those patients with varices, patients with Child-Pugh class B/C were more likely to have large varices.
Dr Zaman's team comments, “Endoscopic screening for varices represents a small proportion of all upper endoscopies performed.”
“This proportion increased between 2000 and 2003.”
“Varices were found more frequently in patients with more severe liver disease.”