Changing Compliance to the American College of Gastroenterology Guidelines for the Management of Variceal Hemorrhage: A Regional Survey

OBJECTIVES: In mid-1997 the American College of Gastroenterology (ACG) published guidelines for the management of varices. The aim of this study is to assess the change in regional practice patterns between early 1997 (preguidelines) and 2000 (postguidelines). METHODS: Gastroenterologists in Oregon and Southwestern Washington state were sent a self-reporting questionnaire regarding the management of varices in March 1997 (prior to the publication of the guidelines) and again in August 2000. RESULTS: Fifty-seven of 75 (76%) and 68 of 92 (74%) of the surveys were completed in 1997 and 2000, respectively. Fifty to 60% of the respondents saw between three and five cirrhotic patients per month. Significantly, more respondents followed the guidelines to screen and treat large varices to prevent initial variceal hemorrhage in 2000 than in 1997, 54% versus 18% (p < 0.005). Of the respondents who performed screening of EGDs, the majority treated large varices with beta-blocker therapy (93% in 1997 and 97% in 2000). All respondents used early endoscopy to treat variceal bleeding. Significantly, most of the respondents began pharmacologic therapy prior to endoscopy if active variceal hemorrhage was suspected (with most choosing octreotide) in 2000 than in 1997, 83% versus 56% (p < 0.005). The majority of the respondents pursued repeat endoscopic therapy after cessation of the initial variceal bleeding episode (96% in 1997 and 95% in 2000), and most performed surveillance EGD once the varices had been eradicated (72% in 1997 and 79% in 2000). CONCLUSIONS: After the publication of the ACG guidelines, significantly more gastroenterologists screened for varices to prevent initial variceal hemorrhage and significantly more used pharmacologic therapy prior to endoscopic treatment for variceal hemorrhage.