The use of screening and preventive therapies for gastroesophageal varicesin patients referred for evaluation of orthotopic liver transplantation

OBJECTIVE: Screening for varices has been recommended in patients with cirr hosis to prevent variceal hemorrhage (primary prophylaxis). III addition, t herapy is recommended after the initial episode of variceal bleeding to pre vent recurrence (secondary prophylaxis). However, the degree of adherence t o these recommendations remains unclear. The pul pose of our study was to d etermine whether these recommendations are being followed in patients prese nting for evaluation of orthotopic liver transplantation. METHODS: One hundred twenty-five patients referred for liver transplantatio n were evaluated. Data regarding demographics, clinical information, releva nt time intervals (diagnosis of cirrhosis to screening, screening to initia l variceal bleeding, variceal bleeding to referral, diagnosis of cirrhosis to referral), screening strategies used, and implementation of primary or s econdary prophylaxis was obtained. The differences among quantitative varia bles were analyzed with Student's t test. Qualitative variables were evalua ted with the Mantel-Haenzel chi (2) test or Fisher's exact test. Statistica l significance was designated at p < 0.05. RESULTS: Out study found that 46% of patients presenting for evaluation of liver transplantation had screening endoscopy or radiological studies to de tect the presence of varices. On the contrary, secondary prophylaxis was pe rformed in all patients with a prior history of variceal hemorrhage. Screen ing fur varices displayed no regional differences. CONCLUSIONS: 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 th e education of physicians to implement screening in this patient population is an important goal. <(c)> 2001 by Am. Cell. of Gastroenterology.