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 of esophagogastric varices and different clinical scenarios remains unclear. This study investigated the use of endoscopic therapy for portal hypertension in China. Methods: This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension. Questionnaires were released online from January 30, 2023 to February 28, 2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces (autonomous regions and municipalities) in China. Comparisons of guideline adherence between primary and referral medical centers were performed using the chi-square test or Fisher's exact test. Results: In total, 836 hospitals participated in the survey. For primary and secondary prophylaxis of esophagogastric variceal bleeding (EGVB), adherence to the national guidelines was 72.5% (606/836) and 39.2% (328/836), respectively. Significant differences were observed in the rate of adherence between 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 endoscopic therapies for acute EGVB, and the timing of endoscopy was usually within 12 h (48.5%, 317/654) and 12–24 h (36.9%, 241/654) after bleeding. Endoscopic therapy was more likely to be the first choice of treatment for acute 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 procedures were cyanoacrylate injection combined with sclerotherapy (48.2% [403/836] and 29.9% [250/836], respectively); however, substantial hospitals preferred clip-assisted therapies (12.4% [104/836] and 26.4% [221/836], respectively). Nonselective beta-blockers were routinely used in 73.4% (614/836) of hospitals during the perioperative period of EGVB management, and propranolol (88.8%, 545/614) and carvedilol (37.5%, 230/614) were the most widely used nonselective beta-blockers. Conclusions: This survey clarified that various endoscopic procedures have been implemented nationwide in China. Participating hospitals have actively performed emergent endoscopy for acute EGVB; however, these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB. In the future, standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.