Endoscopic treatment for gastroesophageal varices in patients with cirrhosis: a survey comparing between developed and developing countries

Background In this survey, we compared endoscopists' approach to treatment of gastroesophageal varices (GOV) in patients with cirrhosis between developed and developing countries. The objective of this study was to undertake a comparative analysis of the approaches employed by endoscopists in developed and developing countries with regard to the treatment of GOV in patients with cirrhosis. Methods Between Jan 2019 to Aug 2019, we administered a questionnaire-based online survey internationally via e-mail. A total of 148 endoscopists from five countries were invited to participate in the survey, and 93 responses were received (response rate: 62.8%). The questionnaire covered several aspects: characteristics of the respondents, primary prophylactics, endoscopic therapy, and secondary prophylactics for acute variceal bleeding (AVB). The answers were compared between developed and developing countries using the chi-square test. For all tests, a P value of < 0.05 was considered significant. Results There was a significant difference between developed and developing countries in practice settings (P = 0.001), the years of independent gastroenterology or endoscopic practice (P = 0.036), treating non-hemorrhagic large gastric varices with medicine (P = 0.019), and selection of preferred initial endoscopic therapy for active gastric fundic variceal bleeding (P = 0.015). Notably, developed and developing countries did not significantly differ in terms of treatment of non-hemorrhagic esophageal varices (P = 0.076), initial endoscopic therapy for active gastric cardia variceal bleeding (P = 0.272), timing of secondary prophylaxis (P = 0.104), timing of endoscopy (P = 0.073), measures for secondary prophylaxis (P = 0.166), and basis for the selection of management preferences (P = 0.278). Conclusion There were some differences in the practice of endoscopists for GOV in patients with cirrhosis between developing and developed countries. We speculate that these differences may affect the costs, management of primary bleeding, and chances of rebleeding in GOV. Furthermore, the equipment and technical conditions of different hospitals may also significantly influence the endoscopist's choice of treatment modality. We hope that future studies will place greater emphasis on this aspect as continuing education of and providing updated equipment to endoscopists are of paramount importance.