Addendum (May 2022)

This 2015 BSG Guideline was recently reviewed by the BSG Liver Section Committee (March 2022). The Guideline covers primary prophylaxis of bleeding, management of acute haemorrhage, and secondary prophylaxis following a variceal bleed. Much of the guidance remains valid, specifically the sections on acute bleeding and secondary prophylaxis, which are in line with current practice and continue to be appropriate. Therefore, the BSG recommend the Guidelines should still be followed in these areas.

However, the topic of primary prophylaxis of variceal bleeding is currently being debated and in the UK is the subject of active clinical trials, with results expected in 2024 and a final update in 2026. 

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool.

The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions.