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World J Hepatol. Mar 27, 2019; 11(3): 250-260
Published online Mar 27, 2019. doi: 10.4254/wjh.v11.i3.250
Update on management of gastric varices
Louisa J Vine, Mohsan Subhani, Juan G Acevedo
Louisa J Vine, Mohsan Subhani, Juan G Acevedo, South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, PL68DH, United Kingdom
Author contributions: All authors contributed to the literature review, analyses, drafting, and critical revision of the manuscript.
Conflict-of-interest statement: All the authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Juan G Acevedo, PhD, Doctor, South West Liver Unit, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, PL68DH, United Kingdom. jacevedo@nhs.net
Telephone: +44-17-52432723 Fax: +44-17-52517576
Received: November 28, 2018
Peer-review started: December 3, 2018
First decision: January 8, 2019
Revised: February 20, 2019
Accepted: February 26, 2019
Article in press: February 27, 2019
Published online: March 27, 2019
Abstract

Gastric varices (GV) have different physiology and clinical characteristics compared to oesophageal varices (OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies’ recommendations are based are scrutinised in this review and areas of research are identified.

Keywords: Gastric varices, Oesophageal varices, Portal hypertension, Cirrhosis

Core tip: This review focuses on an area in Hepatology which needs updating due to the recent contradictory recommendations from different international societies, i.e., American Association for the Study of Liver Disease, Baveno-VI and United Kingdom guidelines. Contradiction arises from lack of strong evidence. This comprehensive review analyses critically the key papers on which recommendations are based, and it also detects areas needing urgent research. There are also graphs and information which would help clinicians in their decision-making process.