Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

Abstract

Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.

Endoscopic Ultrasound-Guided Vascular Procedures: A Review

“…2,8 The standard treatment for GVs is obliteration with cyanoacrylate. 9 Although rare, cyanoacrylate injection has been related to some adverse events, the most notably feared being systemic embolization in up to 2 % to 3 % of cases. 10 Delivery of cyanoacrylate under EUS guidance offers benefits such as the identification of the afferent feeder vessel, precise administration of glue into the varix lumen, and treatment control to confirm vessel obliteration with the assistance of Doppler.…”

Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

“…Gastric varices (GVs) are a common complication associated with portal hypertension [1]. Previous studies [2][3][4][5][6] have found that gastric varices bleeding (GVB) is lower in prevalence compared with oesophageal varices bleeding (EVB) but is associated with considerably higher mortality (45-55%) and rebleeding (35-90%) rates. e current treatment approaches for GVB caused by portal hypertension include endoscopic therapy, radiological intervention methods, and surgical management.…”

Treatment of Bleeding Gastric Varices by Endoscopic Cyanoacrylate Injection: A Developing-country Perspective

“…Its management is challenging, requiring a high amount of blood transfusion, as it can cause an increased rate of rebleeding and increased mortality risk [1]. GV bleeding can be managed by various means; one option is the injection of N-butyl-2-cyanoacrylate (NBCA), or simply cyanoacrylate, under endoscopic guidance [2]. Transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) may also be used for the management of GV bleeding [2].…”