Management Options for Gastric Variceal Hemorrhage

Abstract

irrhosis is a serious complication of liver disease and is commonly caused by viral hepatitis and alcohol consumption. 1,2 Cirrhosis causes abnormal cellular alterations, which increase vascular resistance through the liver. Cirrhosis also comes with cellular damage, tissue fibrosis, liver hardening, nodule formation, and sinusoidal remodeling. Damage to the hepatocytes also results in a disruption of the normal equilibrium between vasodilators and vasoconstrictors and increases total blood flow into the portal system. Endogenous vasodilators such as nitric oxide increase the amount of blood flowing into the portal system by inducing splanchnic arteriolar vasodilation. Following the Ohm law, an increase in vascular resistance along with an increase in portal inflow results in an increase in portal pressure. Subsequently, cirrhosis results in clinical manifestations of portal hypertension.Owing to the variability in severity and progression, cirrhosis is commonly classified into 2 stages: compensated and decompensated. Decompensated cirrhosis is more severe and results in major complications such as ascites, jaundice, encephalopathy and variceal hemorrhage. 1,2 Thus, it is imperative to monitor the progression of compensated cirrhosis and pay close attention to predictive markers of worsening portal hypertension, such as the hepatic venous pressure gradient (HVPG). An HVPG of 10 mm Hg or more is highly

Endoscopic Cyanoacrylate Injection Versus Balloon‐Occluded Retrograde Transvenous Obliteration for Prevention of Gastric Variceal Bleeding: A Randomized Controlled Trial

“…( 28 ) Although limited by mixed indications (both prophylactic and bleeding cases were included), the gastric variceal rebleeding rate is generally considered to be under 10% and as low as 2.7%. ( 27 ) In addition, recurrence of GVs after successful procedures is very rare, possibly because the injected sclerosing agent by an inflated balloon thoroughly destroys the venous endothelium, leading to permanent eradication.…”

The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension

“…Current clinical treatment methods for PPH include splenectomy, splenic artery embolization (SAE), endoscopic sclerotherapy, endoscopic ligation, etc. [ 16 – 18 ]. In clinics, splenectomy combined with pericardial vascular interruption is currently used as a treatment.…”

The combination of balloon-assisted antegrade transvenous obliteration and transjugular intrahepatic portosystemic shunt for the management of cardiofundal varices hemorrhage

“…The treatments for GVs may vary depending on a variety of factors such as the patient's liver function, severity of coexisting esophageal varices, the presence of GRS, and size/ angle of GRS [17]. And the management options mainly consist of two aspects: therapies that reduce portal pressure (β-blockers, TIPS and shunt surgery) and procedures that directly target GVs (endoscopic therapy and BRTO) [4].…”