Introduction Mortality at six weeks for patients with variceal bleeding approaches 10–20%. International and local guidelines state all liver cirrhotic patients should be screened for varices at diagnosis. For primary prophylaxis, non-selective beta-blockers (NSBB) are recommended in patients with small oesophageal varices (OV) with red wale signs or Child C class as well as for patients with gastric varices (GV). Either NSBB or endoscopic band ligation (EBL) is advised for medium sized OVs.1We aim to audit primary prophylaxis in patients on the transplant waiting list.
Method 77 consecutive cirrhotic patients on the liver transplant waiting list from January 2013 to January 2014 were evaluated. Of these 77 patients, 36 (47%) did not live locally therefore had missing data and were excluded from the study. The remaining 41 (53%) patients local to the area were studied.
Results 64% of patients were male, 36% female. The most common aetiologies of liver disease were alcoholic liver disease (30%), Hepatitis C (17%) and PSC (17%).
28 (68%) patients had OVs at screening of which 5 (18%) had at least grade 2 OVs and all patients received either NSBB (40%) or EBL (60%). 8 (29%) patients had OVs which were less than grade 2. Grading of OVs was not specified in 15 (54%) patients, with 8 (53%) of these patients receiving NSBB, 4 (27%) EBL, 2 (13%) both NSBB and EBL and 1 (7%) untreated.
GVs were evident in 3 (7%) patients, 1 of whom had a TIPPS, 1 NSBB and 1 was untreated.
Both OVs and GVs were present in 1 (2%) patient who received a TIPPS.
There were no varices demonstrated in 9 (22%) patients however 2 (22%) received NSBB and 7 (78%) were left untreated.
Out of the 77 patients on the transplant waiting list, there were 12 (16%) deaths, 2 of which were secondary to variceal bleeding. One of these patients had received a TIPSS for GVs and another had EBL for OVs of an unknown grade.
Conclusion Our data demonstrates that reporting of the size of varices could be improved (grading of OVs not specified in 54% of patients). This would have implications of primary prophylaxis being offered to the appropriate patients. Secondly, there was some evidence of lack of adherence with regards to primary prophylaxis but good adherence to current guidelines was demonstrated in patients with grade 2 or larger OVs, which bears the greatest clinical relevance.
Disclosure of interest None Declared.
de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010 Oct;53(4):762–8