Background Esophagogastric variceal bleeding (EGVB) is a severe complication of liver cirrhosis, and modern endoscopic strategies have been recommended as first-line. However, the prevention and treatment of gastric varices and special types of varices remain challenging tissues. In recent years, upper digestive tract hemorrhage in liver cirrhosis has significantly increased in the Southern China area. We investigate the current situation of the use of EGVB in portal hypertension in the Southern China area.

Methods We carried out an online questionnaire survey to investigate the use of endoscopic therapies for EGVB in Guangdong Province, Guangxi Zhuang Autonomous Region, and Hainan Province. Questions included the annual number of procedures, endoscopic choices for preventing EGVB, management of acute EGVB, fundamental treatment of cirrhosis-derived portal hypertension, and the follow-up of endoscopic therapies. Comparisons of guideline adherence among hospitals in different regions were performed using Chi-square or Fisher’s exact test when appropriate.

Results A total of 81 hospitals participated in the study. The survey showed that the leading indication of endoscopic therapies was treating acute EGVB (60.5%). For primary and secondary prophylaxis of EGVB, adherence to the national guidelines was 55.6%, and no significant differences in adherence were observed among different provinces (P=0.976 and 0.186, respectively). As much as 92.6% of hospitals preferred endoscopic therapies treating acute EGVB, and most of the hospitals carried out emergency endoscopies within 12~24 hours after the presentation of bleeding (82.7%). In the treatment of various types of gastric varices and ectopic varices, cyanoacrylate injection-based procedures (including cyanoacrylate injection alone or in combination with sclerotherapy) were the most prevalent procedures. 81.5% of hospitals routinely used non-selective beta-blockers for cirrhosis-derived portal hypertension, and the main drugs were propranolol (80.2%) and carvedilol (19.8%).

Conclusions Various endoscopic procedures for EGVB treatment have been conducted in Southern China. Participating hospitals are active in performing emergency endoscopies for acute EGVB. However, they are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. It is necessary to standardize endoscopic indications further according to different types of varices and improve guideline compliance in the future.