Isolated Gastric Varices: Prevalence, Clinical Relevance and Natural History

Abstract

Background: Isolated ectopic gastric varices (IGV2) are present either in the body or antrum of the stomach or upper duodenum. The prevalence, natural history and clinical significance of these varices has not been adequately described. Materials and Methods: Consecutive patients with portal hypertension, prospectively studied and diagnosed to have IGV2, were assessed for their time of appearance – primary (at first presentation) or secondary (after obliteration of oesophageal varices), association with other varices, portal hypertensive gastropathy and any overt bleeding. Results: Fifty-three of the 1,128 (4.7%) patients had IGV2. The IGV2 were commonly seen in the antrum (53%), duodenum (32%), or at both sites (11%) and rarely in body and fundus (4%). IGV2 were predominantly (84.9%) secondary in origin, developing after oesophageal variceal obliteration. The median time for emergence of secondary IGV2 was 8.2 months for patients with cirrhosis, 12.8 months for non-cirrhotic portal fibrosis and 10.8 months for extra-hepatic portal vein obstruction. Eight (15%) patients had primary IGV2, 6 of them had underlying portal vein obstruction. Portal gastropathy (p < 0.05) and UGI bleeding were more common in the secondary than in primary IGV2. Bleeding due to IGV2 was seen only in 3 (5.7%) patients during a mean follow-up of 36.3 ± 12.1 months, and could be successfully managed with endoscopic ligation or obliteration. Conclusions: Isolated ectopic gastric varices are not uncommon and generally develop following obliteration of main variceal columns. They rarely bleed and often can be managed with endoscopic interventions.

Gastric Varices in Absence of Splenic Vein Thrombosis: A Rare Entity of Idiopathic Non-Cirrhotic Portal Hypertension

“…Gastric varices occur in approximately 20% of the patients with PHT [2]. However, IGV is seen in 5% of cirrhotic patients and up to 10% of NCPH patients [3]. Gastric variceal bleeding develops only in 25% of the patients, yet, it has higher mortality than esophageal variceal bleeding [2].…”

Isolated Gastric Variceal Bleeding Due To Segmental Portal Hypertension Developed As A Consequence of Pancreatic Ductal Adenocarcinoma: A case report

“…Isolated gastric varices are seen approximately 10% in patients with non-cirrhotic portal hypertension (1). Varices develops to decompress the obstruction occurs in any segment of portal vein.…”

“…Isolated gastric varices are may be seen in stomach without esophageal varices (1). Isolated gastric varices are rare pathologies mostly seen in patients with liver cirrhosis.…”

Hemorragia por varices gástricas como manifestación inicial de linfoma pancreático primario

“…Las varices gástricas aisladas pueden apreciarse en alrededor del 5% de los pacientes cirróticos y en alrededor del 10% de los pacientes con HTP no cirrótica 14 .…”