Assessment of stage (clinical and laboratory examination, ultrasound, liver stiffness) Chronic liver disease Findings inducing endoscopy Upper GI endoscopy No varices Small varices* no RCS RCS Small varices Treat etiology/ antifibrotic drugs Success: endoscopy at 2-3 years Failure: endoscopy at 1 year Compensated patient NSBB No follow-up endoscopy Decompensated patient Large varices NSBB or EBL NSBB: no follow-up endoscopy EBL: follow-up endoscopies at 1, 6 and every 12-months Bleeding despite NSBB or EBL Resuscitation (volume replacement, Hb: 7-8 g/dl), vasoactive drugs, antibiotics Endoscopy within 12 h High risk patient Low risk patient EBL (glue in GV) If significant rebleeding or if NSBB are not applicable and no contraindications >5 days Rebleeding prophylaxis: TIPS** Rebleeding prophylaxis Acute bleeding Primary prophylaxis * <5 mm diameter ** if TIPS not possible, try bridging with oesophageal stent or balloon tamponade and always consider LTx repeat ligation + continue NSBB Hepatology Snapshot: Esophageal varices: Stage-dependent treatment algorithm Jaime Bosch 1,2,* , Tilman Sauerbruch 3 1 Liver Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Spain; 2 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Spain; 3 Department of Internal Medicine I, University of Bonn, Germany. *Corresponding author. E-mail address: jbosch@clinic.ub.es (J. Bosch) JOURNAL OF HEPATOLOGY Keywords: Algorithm; Esophageal varices Received 30 September 2015; received in revised form 23 November 2015; accepted 30 November 2015. Journal of Hepatology 2016 vol. xx | xxx–xxx