Management of Gastric Varices.
Clin Gastroenterol Hepatol. 2013 Jul 27;
Authors: Garcia-Pagán JC, Barrufet M, Cardenas A, Escorsell A
According to their location, gastric varices (GV) are classified as gastroesophageal varices (GOV) and isolated gastric varices (IGV). This review will mainly focus in those GV located in the fundus of the stomach (IGV1 and GOV2). The one-year risk of GV bleeding has been reported to be around 10 to 16%. Size of GV, presence of red signs and the degree of liver disfunction are independent predictors of bleeding. Limted data suggests that tissue adhesives, mainly cyanoacrylate (CA), may be effective and better than propranolol in preventing bleeding from GV. General management of acute GV bleeding must be similar to that of esophageal variceal bleeding, including prophylactic antibiotics, a careful replacement of volemia and early administration of vasoactive drugs. Small sample sized randomized controlled trials have shown that tissue adhesives are the therapy of choice for acute GV bleeding. Band ligation may be used in small GV if tissue adhesives are not available. In treatment failures, transjugular intrahepatic portosystemic shunt (TIPS) is considered the treatment of choice. After initial hemostasis, repeated sessions with CA injections along with non-selective beta-blockers are recommended as secondary prophylaxis; whether CA is superior to TIPS in this scenario is not completely clear. Balloon-occluded retrograde transvenous obliteration (BRTO) has been introduced as a new method to treat GV. BRTO is also effective and has the potential benefit of increasing porto-hepatic blood flow and therefore may be an alternative for patients that may not tolerate TIPS. However, BRTO obliterates spontaneous portosystemic shunts potentially agravatting portal hypertension and its related complications. The role of BRTO in the management of GV bleeding is promising but merits further evaluation.
PMID: 23899955 [PubMed - as supplied by publisher]