Assessing the Optimal Time for Gastroesophageal Variceal Surveillance at a Southeastern Tertiary Care Center

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Introduction Gastroesophageal varices (GEVs) are abnormal, pathologic veins that develop due to portal hypertension. A life‐threatening complication of GEV is variceal bleeding, which occurs at a yearly rate of 5%–15%, with a mortality rate of approximately 20%. Traditionally, screening has been performed using esophagogastroduodenoscopy (EGD), as it is both diagnostic and therapeutic, serving as secondary prophylaxis in the management of GEV. While GEV screening guidelines are well established, the optimal follow‐up time frame for variceal monitoring remains unclear, with considerable variability in clinical practice. The primary objectives of this study were twofold: to evaluate whether patients who followed up outside of the recommended time frames (per ASGE guidelines) had different outcomes and to identify patient characteristics that may influence these findings. Methods Adult patients seen at the University of Florida Health Jacksonville between January 1, 2014, and January 31, 2024, with diagnosis codes for GEV or bleeding GEV were included. A total of 235 medical records were reviewed, and 130 patients who had follow‐up endoscopy were included in the statistical analysis. The remaining 105 patients were lost to follow‐up. Statistical analysis was conducted using chi‐squared testing or Fisher’s exact test, with a p v a l u e < 0.05 indicating statistical significance. Repeat interventions were defined as endoscopic variceal ligation (EVL) performed during follow‐up EGD. HRVs were defined as varices > 5 mm, Grades II and III, while low‐risk varices (LRVs) were defined as varices ≤ 5 mm, Grade I. These thresholds were based on existing literature. The “within‐the‐time‐frame” group was based on ASGE guidelines, as not all patients had liver stiffness (LS) data, limiting the use of AASLD/AGA criteria. Results When stratifying patient characteristics by whether repeat interventions occurred on follow‐up EGD, males (66.67%), HRV patients (72%), patients with hemoglobin drops > 1 g/dL (72.72%), and those who underwent incomplete (82.14%) or complete EVL (68.97%) had more repeat interventions compared to their counterparts ( p < 0.05). Patients who had incomplete or complete EVL had significantly more repeat interventions in both the “within‐the‐recommended‐time‐frame” and “outside‐the‐recommended‐time‐frame” groups compared to those managed medically. There was no statistical significance between prior beta‐blocker use, diuretic use, and platelet count on repeat interventions. Additionally, there was no significant difference in repeat interventions across ethnic groups (Caucasians, African Americans, and Hispanics), nor in the rates of patients lost to follow‐up based on ethnicity. Conclusion Male patients with HRV, significant hemoglobin drops, and prior EVL should undergo closer follow‐up with surveillance EGD due to their higher likelihood of requiring repeat interventions. Patients with LRV are less likely to require repeat interventions and may benefit from less aggressive GEV screening protocols. Additional data are needed to refine risk stratification for variceal surveillance and to better understand the risk factors influencing repeat interventions.

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