Endoscopy

Acute bleeding from gastroesophageal varices is a medical emergency that, despite the progress in management achieved in recent years, still carries a 6-weeks mortality of 10% or higher. Nowadays, effective treatments to prevent the first variceal hemorrhage and to treat bleeding exist. For these reasons, several studies have been carried out to identify those patients at high risk for a first variceal hemorrhage, in order to select them for prophylactic therapy. Over the last 50 years, endoscopy has extensively been used to diagnose and classify portal hypertension related lesions, including esophageal end gastric varices and portal hypertensive gastropathy. This chapter describes the endoscopic methods used to diagnose these lesions and the results of studies aimed at stratifying patients into risk classes for bleeding.