A 55-year-old man with cirrhosis undergoes upper GI endoscopy, which shows small esophageal varices without red signs and no gastric varices. He has never bled. According to Baveno VII criteria, which is the recommended management?

• A Start non-selective beta-blocker (propranolol) for primary prophylaxis
• B Repeat endoscopy in 1 to 2 years; no pharmacotherapy needed now ✓
• C Endoscopic variceal ligation (EVL) for primary prophylaxis
• D Start carvedilol for primary prophylaxis

Explanation

Baveno VII criteria state that patients with compensated cirrhosis and small varices without red signs who are not on beta-blockers can be followed with repeat endoscopy in 1 to 2 years. Non-selective beta-blockers or EVL are recommended only for medium/large varices or small varices with red signs or Child-Pugh B. Carvedilol is an option for medium/large varices but is not indicated for small varices without high-risk features. This reflects the shift toward risk-stratified primary prophylaxis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.