New methods for the management of gastric varices

Abstract

Bleeding from gastric varices has been successfully treated by endoscopic modalities. Once the bleeding from the gastric varices is stabilized, endoscopic treatment and/or interventional radiology should be performed to eradicate varices completely. Partial splenic artery embolization is a supplemental treatment to prolong the obliteration of the veins feeding and/or draining the varices. The overall incidence of bleeding from gastric varices is lower than that from esophageal varices. No studies to date have definitively characterized the causal factors behind bleeding from gastric varices. The initial episodes of bleeding from esophageal varices or gastric varices without prior treatment may be at least partly triggered by a violation of the mucosal barrier overlying varices. This is especially likely in the case of varices of the fundus. In view of the high rate of hemostasis achieved among bleeding gastric varices, treatment should be administered in selective cases. Among untreated cases, steps to prevent gastric mucosal injury confer very important protection against gastric variceal bleeding.

Efficacy of Combined Balloon-occluded Retrograde Transvenous Obliteration and Simultaneous Endoscopic Injection Sclerotherapy

“…Generally, the sclerosant used in the B-RTO procedure is 5% ethanolamine oleate iopamidol (EOI) and is slowly injected through the catheter until the shunt is filled (2). Some researchers have reported variations in the B-RTO procedure and/or the use of other F3 lesions (Fig.…”

“…Previous studies have reported an incidence of GVs of only 4% in cirrhotic patients without bleeding, while other reports have shown that 25% of cirrhotic patients have GVs on screening endoscopy (1). The natural history of bleeding from GVs is generally thought to be more severe than that from esophageal varices (EVs), although it occurs less frequently (2). Rupture of GVs is a serious condition associated with a mortality rate of 25-55% (3).…”

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children

“…Therefore, the volume of blood flow through fundal varices usually exceeds that through esophageal varices [8]. After endoscopic treatment, a mucosal injury remains on the varices, and bleeding may recur at the site of the injury [9]. In addition, intravariceal blood flow is too fast to permit the injection of sufficient sclerosant when treating by endoscopic injection sclerotherapy (EIS).…”

Serum type IV collagen level is predictive for esophageal varices in patients with severe alcoholic disease

“…The purpose of endoscopy was to evaluate the presence of esophageal varices ( Figure 1). The endoscopist evaluated esophageal varices with the Esophagogastric Varices Grading System of the Japan Society for Portal Hypertension [10] . The endoscopist performed UGI endoscopy without knowledge of serum data.…”