Introduction Portal hypertension is a group of syndromes caused by persistent elevation of portal pressure for various reasons, of which liver cirrhosis is the most common cause
The prevalence of gastric varices (GV) in portal hypertension is 17%-25%, while the prevalence of esophageal varices (EV) is 85%
In the setting of cirrhosis and portal hypertension, GV occurs in 20% of EV patients, usually due to elevated splenic venous pressure
Sometimes in the absence of cirrhosis, portal vein occlusion can present with isolated GV
GVs can bleed at low pressures, are usually more bleed, and have higher rates of transfusion, uncontrolled bleeding, rebleeding, and mortality
Recently, Gastroenterology (impact factor 22.
682) published a review that mainly summarizes the management of GV bleeding
One-figure summary: Management of GV bleeding Treatments for GV bleeding include drug therapy, endoscopic cyanoacrylate injection (ECI), and endovascular intervention
Although ECI is relatively easy to perform and effective, due to the complexity of shunts and collateral access, this review advocates the use of endovascular procedures for effective treatment, such as balloon occlusion retrograde transvenous occlusion (BRTO), vascular plug-assisted retrograde transvenous occlusion Obliteration (PARTO) or coil-assisted retrograde transvenous occlusion
The choice of treatment depends on safety, availability of local resources, cost of treatment, and skill level
If the patient presents with acute bleeding, all GVs should be treated by emergency endoscopy and ECI (Figure 1)
Figure 1 Approach to the management of GV bleeding *In cases where bleeding persists despite adequate ECI, it should be discussed by a multidisciplinary team including hepatologists, endoscopists, interventional radiologists** Chronic PVT with collaterals BRTOPV, portal vein; PVT, portal vein thrombosis; HE, hepatic encephalopathy; TIPS, transjugular intrahepatic portosystemic shunt; EUS, endoscopic ultrasonography References: Maydeo A, Patil G.
How to Approach a Patient With Gastric Varices[J].
2021 Dec 31:S0016-5085(21)04173-1.