HVPG reduction >= 20% from baseline predicts response
HVPG < 12 mmHg ideal target rarely achieved
Patient Discharge Instructions
copy discharge instructions
Esophageal varices home care
Take your beta-blocker medication every day without missing doses
Do not stop it suddenly without calling your doctor
Report dizziness, fainting, or very slow pulse
Absolute alcohol avoidance
Single most important action to slow liver disease progression
Avoid ibuprofen, naproxen, aspirin, and all NSAIDs
Increases risk of stomach bleeding and kidney injury
Low-sodium diet less than 2 g per day if you have fluid retention
Return to ER immediately for
Vomiting blood or material that looks like coffee grounds
Call 911 or go by ambulance
Black tarry or very dark stools
Dizziness or fainting
Sudden severe abdominal pain
Confusion, unusual sleepiness, or difficult to rouse
Fever above 38.5 degrees Celsius with your liver condition
Rapid increase in abdominal swelling
Follow-up appointments
Gastroenterology or hepatology within 1 to 2 weeks of discharge
Repeat band ligation procedure scheduled every 2 to 4 weeks until cleared
Blood work as directed
Liver function and kidney function testing
Liver cancer screening ultrasound every 6 months
Lifestyle and recovery
Adequate protein intake 1.2 to 1.5 g per kg body weight per day
Important to maintain muscle mass with liver disease
Early feeding within 72 hours after endoscopy procedure
Physical activity as tolerated once discharged
References
Guidelines and key sources
Society guidelines
AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis 2024
Kaplan DE et al Hepatology 2024
Comprehensive management framework including carvedilol and TIPS recommendations
Baveno VII Consensus 2022
De Franchis R et al Journal of Hepatology 2022
NSBB and EVL primary prophylaxis recommendations
Pre-emptive TIPS criteria updated
American Society for Gastrointestinal Endoscopy guideline 2014
Hwang JH et al Gastrointestinal Endoscopy 2014
EVL as first-line endoscopic therapy
Key clinical trials and systematic reviews
Cochrane review on band ligation versus no intervention for primary prevention
Vadera S et al Cochrane Database of Systematic Reviews 2019
EVL efficacy for primary prophylaxis
Restrictive versus liberal transfusion RCT
Haemoglobin 70 g/l target improves survival in variceal bleeding
Class I recommendation basis
Early TIPS versus pharmacologic plus endoscopic therapy RCT
Pre-emptive TIPS 1-year survival 86% vs 61%
High-risk population Child-Pugh B active bleed or Child-Pugh C
Background and epidemiology references
Tapper EB and Parikh ND JAMA 2023
Diagnosis and Management of Cirrhosis and Its Complications
Arroyo V et al NEJM 2020
Acute-on-Chronic Liver Failure
Singh S et al World Journal of Gastroenterology 2024
Comprehensive Approach to Esophageal Variceal Bleeding
ICD-10 coding
ICD-10 I85.01 esophageal varices with bleeding
Acute variceal haemorrhage
ICD-10 I85.11 secondary esophageal varices with bleeding
ICD-10 K74.60 unspecified cirrhosis of liver
ICD-10 K22.6 Mallory-Weiss syndrome as differential
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.