Endoscopic and radiological appraisal of gastric varices

Abstract

Of 104 patients with portal hypertension who were subjected to oesophageal variceal sclerotherapy, gastric varices were seen in 81 (78 per cent) at endoscopy and 69 (74 per cent) at splenoportography. In 50 (48 per cent) patients gastric varices were seen at the initial endoscopic examination and in 31 they developed during follow-up at intervals varying from 1 to 56 weeks. Gastric varices were seen significantly more often along the lesser curvature than in the gastric fundus and the left gastric vein was the main feeding vessel in 75 per cent of cases. Varices bled in nine of 81 patients and bleeding was seen significantly more often from fundal varices (30 per cent) than from lesser curve varices (5 per cent) (P less than 0.02). The incidence of gastric varices is high, and contrary to popular belief they are more often located along the lesser curvature of the stomach than in the gastric fundus.

Portal hypertension and variceal bleeding: An AASLD single topic symposium

“…However, there is great variability in the reported figures concerning the prevalence, [136][137][138][139] the incidence of bleeding and rebleeding, 139,140 and the fate of gastric varices after endoscopic sclerotherapy of esophageal varices. 136,138,[141][142][143][144][145] Plausible reasons for the discrepancies are (1) difficulty in the diagnosis, (2) differences in the criteria of classification, (3) differences in the stage of portal hypertension, the severity of cirrhosis, and the prevalence of previous sclerotherapy, and (4) differences in the cause of portal hypertension among studies. Several methods have been proposed to treat bleeding gastric varices.…”

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

“…19 EIS with 5% EOI has sometimes not been indicated for the treatment of solitary gastric varices, because the blood flow in the varices is so rapid that it can not damages the endothelium of the varices and the sclerosant is likely to migrate into the systemic circulation. 20,21 If we wish to treat gastric varices by EIS with 5% EOI, the method of balloon endoscopic sclerotherapy developed by Matsumoto et al 22 is required. The procedure we used included endoscopic injection of sclerosant while the gastrorenal shunt was temporarily occluded with a balloon catheter.…”

Massive Gastric Variceal Bleeding in a Patient with Chronic Pancreatitis

“…New studies that compare splenoportography and endoscopy reveal that even 90% of gastric varices are able to be diagnosed endoscopically. 7 Finding of isolated gastric varices during upper endoscopy always require work-up to find if possibly splenic vein thrombosis exists. Generally ultrasound with Doppler is the first method to be done in patients with portal hypertension.…”