Natural history of cirrhotic patients with small esophageal varices: A prospective study

OBJECTIVE: Contrasting data are available on the natural history and bleedi ng risk of small esophageal varices. The aim of this prospective study was to evaluate a large series of consecutive cirrhotics with a first endoscopi c diagnosis of small varices. METHODS: Between 1987 and 1992, 258 patients with small varices and no prev ious bleeding were enrolled. Patients were clinically examined every 6 mont hs and were followed until a first episode of bleeding and/or death, or unt il June 1998. None received any treatment to prevent bleeding. Endoscopies were planned at 18-month intervals. RESULTS: The cumulative risk of bleeding was low (3% at 2 yr and 8% at 4 yr ) and remained low in patients in whom varices remained small at 2nd endosc opy, whereas it increased significantly when varices enlarged. The increase of varices appeared to be rather linear in time: at the 2nd endoscopy vari ces remained small in 79% of patients and increased in 21%; at the 3rd endo scopy varices remained small in 55%, whereas at the 4th 33% of patients sti ll had small varices. Clinical and biochemical data at the Ist and 2nd endo scopy were included in a multiple logistic regression analysis. Only the in crease in Child-Pugh score appeared to be a significant predictor of enlarg ed varices; the risk of aggravation increased by 37.5% for every unit of im pairment of the score. CONCLUSIONS: The present study shows that patients with small varices have a low bleeding risk. An increase in Child-Pugh score during follow-up sugge sts enlargement of varices, thus an increase in bleeding risk. In these pat ients closer endoscopic surveillance is recommended. (C) 2000 by Am. Cell. of Gastroenterology.