Table 2.

Summary of recommendations by notable international guidelines/guidance

Guideline		APASL 2008/2011	AASLD2017	EASL2018	KASL2020
Screening and monitoring of EGV
	EGD screening	LC patients	LC patients with TE >20 kPa and platelet count <150,000/mm3	Decompensated LC patients	LC patients
	EGD monitoring	Every 2 years for patients with no varices on screening	When decompensation occur	Every year for patients with no varices and ongoing liver injury/decompensation	Every 1-2 years for decompensated LC
			Every year： compensated with small varices and ongoing liver injury
			Every 2 years： compensated with small varices and inactive liver injury/no varices and ongoing liver injury		Every 2-3 years for compensated LC
			Every 3 years： compensated with no varices and inactive liver injury
Primary prophylaxis of EV bleeding
	Preprimary prophylaxis	No treatment recommended	Eliminate etiologic agent, NSBB not recommended	No recommendations	Treat underlying liver disease, NSBB not recommended
	Early primary prophylaxis	NSBB for high-risk small EV	NSBB for both low-risk and high-risk small EV	NSBB for high-risk small EV	NSBB or carvedilol for low-risk small EV
					NSBB for high-risk small EV
	Primary prophylaxis	NSBB with HVPG monitoring or EVL	NSBB, carvedilol, or EVL	NSBB or EVL	NSBB, carvedilol, EVL, or combination of NSBB and EVL
Primary prophylaxis of GV bleeding
	GOV1	Follow recommendations for EV	Follows recommendations for EV	Follows recommendations for EV	Follows recommendations for EV
	GOV2 or IGV1	NSBB or BRTO in centers with expertise	NSBB	NSBB	BRTO, PARTO, or EVO
Acute variceal bleeding
	Blood transfusion	Conservative/restrictive red blood cell transfusion	Conservative/restrictive red blood cell transfusion	Conservative/restrictive red blood cell transfusion	Conservative/restrictive red blood cell transfusion
	Antibiotic prophylaxis	Ceftriaxone IV 2-4 g per day for 5-7 days	Ceftriaxone IV1 g per day for maximum 7 days	Ceftriaxone IV1 g per day for 7 days only for decompensated, on quinolones, or high resistance; oral quinolones for the rest	Ceftriaxone IV1 g per day for maximum 7 days
	Vasoconstrictor	Terlipressin first choice; somatostatin, octreotide, or vapreotide when not available	Somatostatin, octreotide, vasopressin, or terlipressin	Terlipressin, somatostatin, or octreotide	Terlipressin, somatostatin, or octreotide
	Endoscopic therapy for EV bleeding	EVL	EVL	EVL	EVL
	Endoscopic therapy for GOV1	EVL or EVO	EVL or EVO	EVL	EVO or EVL
	Therapy for GOV2 or IGV1	EVO,TIPS,orBRTO	TIPS or EVO when TIPS is not feasible	EVO, TIPS with embolization, or BRTO/BATO for GV with large gastro/splenorenal collaterals	EVO (considered first), BRTO/PARTO,orTIPS
	Rescue therapy for EV bleeding	TIPS	TIPS	TIPS	TIPS
	Early TIPS	Within 24 hours in HVPG >20 mmHg	Within 72 hours in CP class C or CP class B with active bleeding	Within 24-72 hours in CP class C <14	In patients at high risk of re bleeding
Secondary prophylaxis
	After EV bleeding	No recommendation	NSBB and EVL except for post-TIPS patients; TIPS as rescue therapy	NSBB and EVL, or covered TIPS for NSBB intolerant patients	NSBB and EVL (alone if difficult); TIPS as rescue therapy
	After GOV1 bleeding	No recommendation	NSBB and EVL/EVO	No recommendation	EVO or EVL
	After GOV2 or IGV1 bleeding	No recommendation	TIPSorBRTO	No recommendation	EVO or BRTO/PARTO

APASL, the Asian Pacific Association for the Study of the Liver; AASLD, the American Association for the Study of Liver Diseases; EASL, the European Association for the Study of the Liver; KASL, the Korean Association for the Study of the Liver; EGV, esophagogastric varices; EGD, esophagogastroduodenoscopy; LC, liver cirrhosis; TE, transient elastography; EV, esophageal varices; NSBB, non-selective beta blocker; HVPG, hepatic vein pressure gradient; EVL, endoscopic variceal ligation; GOV1, type 1 gastroesophageal varices; GOV2, type 2 gastroesophageal varices; IGV1, type 1 isolated gastric varices; BRTO, balloonoccluded retrograde transvenous obliteration; PARTO, plug-assisted retrograde transvenous obliteration; EVO, endoscopic variceal obturation; TIPS, transjugular intrahepatic portosystemic shunt; BATO, balloonoccluded antegrade transvenous obliteration; GV, gastric varices; CP, Child-Pugh.