Upper Endoscopy (EGD) for Esophageal Varices

Endoscopy lets the doctor see the esophagus directly. EGD (upper endoscopy) is the standard way to screen for esophageal varices, and it shows details that imaging and blood tests cannot show as reliably. Through a thin, flexible camera, the doctor can measure the size of any varices and check for red wale marks, which are red streaks that signal a higher risk of bleeding. Those findings decide whether you need preventive treatment now or only repeat exams later. Guidelines recommend a screening EGD for people who develop signs of liver decompensation, unless varices were already found and treated. People whose advanced fibrosis or cirrhosis was present before hepatitis C treatment can still develop portal hypertension complications, so they may need screening too.

Yes, in many cases. If the doctor finds varices at high risk of bleeding, they can treat them in the same session with endoscopic variceal ligation, also called banding. That means you avoid a separate procedure. During banding, the doctor places small elastic bands around the enlarged veins. The bands cut off the blood supply, so the varices shrink and scar over time. This lowers the risk of bleeding. Not every varix needs banding. Small varices usually carry a lower bleeding risk and are watched with repeat exams. Medium or large varices, and those with red wale marks, are typically treated with non-selective beta-blockers or banding. After banding, you will likely need follow-up endoscopies to confirm the varices have shrunk, and sometimes more banding sessions.

There is no single schedule. How often you repeat EGD depends on what your earlier exams showed and how severe your liver disease is, and your doctor will set the timing for you. Guidelines recommend a screening EGD for anyone who develops signs of liver decompensation, unless varices were already diagnosed and treated. If you have small varices, your doctor may repeat the exam on a schedule guided by their size, to see whether they have grown or become higher risk. If you have banding, expect follow-up endoscopies to check the treated varices and look for new ones. Keep every scheduled appointment, even if you feel well.

Most people feel little to no discomfort during the procedure. You receive sedation through an IV, so you are relaxed or asleep during the exam, which usually takes 15 to 30 minutes. After the exam, a sore throat or mild chest discomfort is common and usually passes quickly. You are monitored for a short time while the sedation wears off, and most people go home the same day. Because of the sedation, avoid driving, operating machinery, or making important decisions for the rest of the day. Follow your care team's instructions about not eating or drinking for several hours beforehand.

The risks are generally low. EGD is generally safe, and the most common effects are a sore throat or mild chest discomfort afterward. Less common risks include bleeding. If banding is performed, ulcers can form at the sites where bands were placed. Rare but serious risks include narrowing of the esophagus or a tear in its wall (perforation). These risks need to be weighed against the danger of untreated high-risk varices, which can rupture and bleed. Your care team will explain the risks that apply to your situation before the procedure.