American Association for the Study of Liver Diseases

View all recommendations from this society

Released June 15, 2014

Don’t perform surveillance esophagogastroduodenoscopy (EGD) in patients with compensated cirrhosis and small varices without red signs treated with non-selective beta blockers for preventing a first variceal bleed.

In patients with cirrhosis and small varices that have not bled and have no criteria for increased risk of bleeding (Child A, no red signs on varices), beta blockers can be used. In patients with cirrhosis and medium or large varices that have not bled and are not at the highest risk of bleeding (Child A and no red signs), beta blockers are preferred, adjusted to the maximal tolerated dose. In both scenarios, follow-up EGD is not necessary.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Association for the Study of Liver Diseases (AASLD) established a Choosing Wisely® Task Force in December 2013 to develop its list of recommendations. Members of this group were selected from the AASLD Practice Guidelines Committee to broadly represent varying practice settings and subspecialty expertise within the field of hepatology. Hepatologists with methodological experience in evidence-based medicine were also included. The working group solicited recommendations from the entire AASLD membership that should be considered for inclusion in the list of “Five Things Physicians and Patients Should Question”. These recommendations were then rated based upon judgments related to harm, benefit and excess resource utilization. Based on working group voting and literature review, a total of 10 suggestions were identified with subsequent voting by the working group to generate the final Top Five recommendations. These recommendations were submitted and approved by AASLD Governing Board.

AASLD’s disclosure and conflict of interest policy can be found at


Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; Practice Guidelines Committee of the American Association for the Study of Liver Diseases;Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varicesand variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922–38.