When and how to scope in portal hypertension

摘要

Portal hypertension (PH) plays a crucial role in the transition from the preclinical to the clinical phase of cirrhosis. PH is a contributing factor for the development of ascites and hepatic encephalopathy and a direct cause of variceal haemorrhage and of bleeding-related death. The increase of portal pressure leads to the development of a collateral circulation, of which oesophago-gastric varices are the most important feature from a clinical standpoint. Varices tend to increase in size in parallel with the increase in portal pressure, and rupture when variceal wall tension exceeds a critical level. Bleeding from oesophagogastric varices is the most important complication of cirrhosis, marking the progression of decompensation of the disease to a stage with an extremely high risk of death1. It should be noted that, despite the advances achieved in recent decades in its treatment, variceal bleeding still carries a mortality of around 20% within 6 weeks of the bleeding episode .