Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types ofesophagogastric varices and different clinical scenarios remains unclear. Thisstudy investigated the use of endoscopic therapy for portal hypertension inChina.Methods:This study used a questionnaire survey initiated by the Liver HealthConsortium in China to investigate the use of endoscopic therapies for portalhypertension. Questionnaires were released online from January 30, 2023 toFebruary 28, 2023 andfilled out by chief physicians or senior instructorsresponsible for endoscopic therapies in participating hospitals across 31provinces (autonomous regions and municipalities) in China. Comparisonsof guideline adherence between primary and referral medical centers wereperformed using the chi-square test or Fisher's exact test.Results:In total, 836 hospitals participated in the survey. For primary andsecondary prophylaxis of esophagogastric variceal bleeding (EGVB), adher-ence to the national guidelines was 72.5% (606/836) and 39.2% (328/836),respectively. Significant differences were observed in the rate of adherencebetween the primary and referral centers for primary (79.9% [111/139] vs.71.0% [495/697],p= 0.033) and secondary prophylaxis (27.3% [38/139] vs.41.6% [290/697],p= 0.002). Of the hospitals, 78.2% (654/836) preferred en-doscopic therapies for acute EGVB, and the timing of endoscopy was usuallywithin 12 h (48.5%, 317/654) and 12-24 h (36.9%, 241/654) after bleeding.Endoscopic therapy was more likely to be thefirst choice of treatment foracute EGVB in referral centers than in primary centers (82.6% [576/697] vs.56.1% [78/139],p< 0.001). Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, the most prevalent proce-dures were cyanoacrylate injection combined with sclerotherapy (48.2% [403/836] and 29.9% [250/836], respectively); however, substantial hospitals pre-ferred clip-assisted therapies (12.4% [104/836] and 26.4% [221/836], respec-tively). Nonselective beta-blockers were routinely used in 73.4% (614/836) ofhospitals during the perioperative period of EGVB management, and pro-pranolol (88.8%, 545/614) and carvedilol (37.5%, 230/614) were the mostwidely used nonselective beta-blockers.Conclusions:This survey clarified that various endoscopic procedures havebeen implemented nationwide in China. Participating hospitals haveactively performed emergent endoscopy for acute EGVB; however, thesehospitals do not adequately follow recommendations regarding primary andsecondary prophylaxis of EGVB. In the future, standardizing the selectionof endoscopic procedures and improving compliance with guidelines iscrucial.