Endoscopic treatment of gastric variceal bleeding Jerzy Żurakowski Medical Science Review - Hepatologia 2009; 9 73-84 aaICID: 902248
Article type: Review article
IC™ Value: 3.04
Abstract provided by Publisher
Gastric varices GVs) are found at the first endoscopic examination in approximately 20% of patients with portal hypertension. Compared with esophageal variceal bleeding, gastric variceal bleeding occurs less commonly but is generally more profuse and more difficult to control, especially with endoscopy. GVs are classified according to their location in the stomach and their relationship with esophageal varices into two types: GOV (gastroesophage-al varices) and IGV (isolated varices). GOVs are subdivided into two types. Type 1 (GOV1) are extensions of esophageal varices along the lesser curve of the stomach and type 2 (GOV2) (esophageal and fundal varices) extend from the esophagus towards the fundus and tend to be longer and more tortuous. Isolated varices (IGV) occur in the absence of esophageal varices. They are subdivided into type 1 varices (IGV1) located in the fundus which are often tortuous and type 2 (IGV2) ectopic varices located in the antrum, body, or the pylorus itself. GOVs should be treated like esophageal varices, preferentially with band ligation. However, the treatment of fundal gastric varices (GOV2 and IGV1) still presents a challenge. They respond poorly to the treatment modalities used in bleeding esophageal varices. Endoscopic injection sclerotherapy for fundal gastric varices with traditional sclerosants has unacceptably high rebleeding rates and high mortality. Banding ligation for large gastric varices may be dangerous as it may result in catastrophic hemorrhage due to an inability to contain the entire gastric varix in the ligation barrel. Detachable snare ligation has been successfully used in a small number of cases for large fundal gastric varices, but experience is limited. There is accumulating evidence in the literature that endoscopic obliteration using cyanoacrylate tissue adhesive should be used as the first-line treatment of acute fundal gastric variceal bleeding. Using thrombin for obliteration of bleeding gastric varices represents another promising treatment option, but experience is limited and this modality requires further investigation.