Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database

Abstract

The current guidelines for primary prophylaxis of variceal hemorrhage in cirrhotic patients recommend screening for varices with upper endoscopy (EGD). Utilization and outcomes of screening in clinical practice are unknown. Our purpose was to determine the use of endoscopic variceal screening in diverse practice settings and to determine factors associated with the finding of esophageal varices. Endoscopic reports generated by the Clinical Outcomes Research Initiative (CORI) repository were analyzed to determine the use, changes over time, and findings of screening upper endoscopies between January 1, 2000, and December 31, 2003. Data from 68 CORI practices (70% community/17% academic/13% Veterans Affairs Medical Center [VAMC]) were evaluated. A total of 1688 of 172,854 EGDs were performed for the purpose of screening for varices. Overall, there was a linear increase in annual proportion of screening EGDs performed (P < .0001). A significantly greater proportion of variceal screening EGDs are performed in academic centers compared with VAMC and community practices. Varices were found in 881 screened patients (52.2%). Varices were found more often in Child-Pugh class B/C (71.9%) compared with Child-Pugh class A (42.7%) patients. Of those with varices found, patients with Child-Pugh class B/C were more likely to have large varices than were patients with Child-Pugh class A (P = .02). A limitation of this study was the inability to determine the total number of cirrhotic patients cared for at each CORI site included in this study. Endoscopic screening for varices represents a small proportion of all upper endoscopies performed. This proportion increased between 2000 and 2003. Varices were found more frequently in patients with more severe liver disease.