Safety of endoscopy in patients with end-stage liver disease.

Patients with end-stage liver disease routinely undergo an upper endoscopy for the diagnosis and management of complications of portal hypertension. These cirrhotic patients inherently have additional risks and higher rates of complications secondary to their liver disease and the presence of portal hypertension. Additional considerations and precautions must be taken into account to ensure that the endoscopic procedure is performed with the minimal risks possible. This article discusses the management of cirrhotic patients undergoing endoscopy. It addresses clinical clues for identifying the cirrhotic patient, the use of medications and monitoring equipment for vital signs during endoscopy, blood product administration in acute upper gastrointestinal bleeding, and elective and urgent procedures to diagnose and treat cirrhotic patients.