Published online May 16, 2014. doi: 10.4253/wjge.v6.i5.168
Revised: April 3, 2014
Accepted: April 16, 2014
Published online: May 16, 2014
Although less common than oesophageal variceal haemorrhage, gastric variceal bleeding remains a serious complication of portal hypertension, with a high associated mortality. In this review we provide an update on the aetiology, classification and management of gastric varices, including acute bleeding, prevention of rebleeding and primary prophylaxis. We describe the optimum management strategies for gastric varices including drug, endoscopic and radiological therapies, focusing on recent published evidence.
Core tip: Endoscopic injection of cyanoacrylate is currently the optimum, evidenced based approach to control active bleeding from gastric varices, apart from bleeding from gastro-oesophageal varice (GOV)-1 which can be treated with variceal band ligation. Transjugular intrahepatic portosystemic shunt (or balloon-occluded retrograde transvenous obliteration in experienced units) can be effective for ongoing bleeding. Cyanoacrylate or transjugular intrahepatic portosystemic shunt can prevent rebleeding from GOV-2 or isolated gastric varice, although variceal band ligation, cyanoacrylate or β-blockers can be used after bleeding from GOV-1. Non-selective β-blockers or cyanoacrylate may be used as primary prophylaxis in patients with known gastric varices, with the choice dependent on clinical and endoscopic findings.