[Criteria for the endoscopic assessment of hemorrhage risk in esophageal varices]

The natural history of liver cirrhosis shows one third of patients bleeding from esophageal varices. The first episode of bleeding has a 40% mortality rate and 70% of survivors will have another haemorrhage within a year. To overcome this dramatic sequence the following types of prophylactic treatment have been attempted: portocaval shunt, B-blockers, endoscopic sclerotherapy. Medical Literature shows no proven benefits from these procedures. Endoscopic sclerotherapy seems to have the best results. Thus, to be more successful we suggest a better selection of patients to undergo prophylactic sclerotherapy, also improving the prognostic criteria which could predict the bleeding. Esophagoscopy makes it possible to examine some of the predictive signs of impending haemorrhage. However, both the endoscopic and clinical criteria (Child) give a better evaluation of the risk of bleeding.