Varices and variceal hemorrhage are important and challenging complications that lead to decreased survival in patients with cirrhosis. Their proper management will lead to improvement in survival, according to presenters in Monday’s AASLD Clinical Symposium Update on the Management of Gastroesophageal Varices.
The session will focus on risk stratification (using invasive and non-invasive tools) that will identify patients who will be more (or less) likely to benefit from certain therapies, with regard to not only variceal hemorrhage but also the prevention/treatment of other complications of cirrhosis.
“This symposium will address the current knowledge on non-invasive methods to detect patients who are unlikely to have high-risk varices. In addition, the speakers will define current recommendations regarding the prevention of bleeding or rebleeding as well as management of patients with acute esophageal or gastric variceal bleeding,” said co-moderator Brett E. Fortune, MD, assistant professor of medicine at Weill Cornell Medical College, Cornell University, Ithaca, NY.
Strategies will be discussed in a case-based setting that will illuminate current concepts regarding risk stratification and therapies for portal hypertension/varices at different stages of cirrhosis.
“This session will highlight the current advances in non-invasive modalities to detect patients in whom endoscopy may be avoided. Other goals for the session include discussion on the use of beta blockers in advanced liver patients, use of pre-emptive transjugular intrahepatic portosystemic shunt (TIPS), and the multi-disciplinary approach for handling bleeding gastric varices,” added co moderator Guadalupe Garcia-Tsao, MD, FAASLD, professor of medicine at Yale University, New Haven, CT.
Don C. Rockey, MD, FAASLD, professor and chairman of the department of medicine at the Medical University of South Carolina, Charleston, will start the session with a review of a patient with new cirrhosis diagnosis, followed by Dr. Garcia-Tsao reviewing a case of a patient with large varices, ascites and a recent history of spontaneous bacterial peritonitis.
Elizabeth Verna, MD, MS, assistant professor of medicine and director of clinical research at Columbia University Transplant Initiative, will present on a patient with Child C cirrhosis admitted with acute esophageal variceal hemorrhage, and Dr. Fortune will review a case of a patient admitted with bleeding gastric fundal varices.
A panel discussion will follow the case presentations.
Drs. Fortune and Garcia-Tsao noted that the key takeaways will be that the management of varices and variceal hemorrhage must now be taken in the context of the presence (or absence) of other complications of cirrhosis. Risk stratification will allow for a more individualized treatment strategy, they added.
Please refer to the DDW Mobile App or the Program section in the Monday issue for the time and location of this and other DDW® events.