Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jan 21, 2019; 10(1): 1-21
Published online Jan 21, 2019. doi: 10.4292/wjgpt.v10.i1.1
Update on the management of gastrointestinal varices
Umesha Boregowda, Chandraprakash Umapathy, Nasir Halim, Madhav Desai, Arpitha Nanjappa, Subramanyeswara Arekapudi, Thimmaiah Theethira, Helen Wong, Marina Roytman, Shreyas Saligram
Umesha Boregowda, Chandraprakash Umapathy, Nasir Halim, Arpitha Nanjappa, Thimmaiah Theethira, Marina Roytman, Shreyas Saligram, Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
Madhav Desai, Department of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, KS 66160, United States
Subramanyeswara Arekapudi, Department of Medicine, VA Central California Healthcare System, Fresno, CA 93703, United States
Helen Wong, Shreyas Saligram, Department of Gastroenterology and Hepatology, VA Central California Healthcare System, Fresno, CA 93703, United States
Author contributions: Boregowda U contributed to conception and design of the article, acquisition and interpretation of data, and drafting the article; Umapathy C, Halim N, Desai M and Nanjappa A contributed to drafting the article; Arekapudi S, Theethira T, Wong H and Roytman M contributed to making critical revisions related to important intellectual content of the manuscript; Saligram S contributed to conception and design of the article, acquisition, analysis and interpretation of data; making critical revisions related to important intellectual content of the manuscript; and final approval of the version of the article to be published.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
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: Shreyas Saligram MD, MRCP, Assistant Professor, Director, Doctor, Department of Gastroenterology and Hepatology, University of California San Francisco, 2823 Fresno Street, Fresno, CA 93721, United States. ssaligram@fresno.ucsf.edu
Telephone: +1-559-4593821 Fax: +1-559-4593887
Received: August 27, 2018
Peer-review started: August 27, 2018
First decision: October 5, 2018
Revised: October 24, 2018
Accepted: December 10, 2018
Article in press: December 11, 2018
Published online: January 21, 2019
Abstract

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

Keywords: Portal hypertension, Esophageal varices, Gastric varices, Ectopic varices, Endoscopy

Core tip: Cirrhosis of liver can lead to gastrointestinal varices. Gastrointestinal bleed from varices can be debilitating and can cause morbidity and mortality if not well controlled. This is a detailed review on the endoscopic management of variceal bleed and gives an insight into some of the new endoscopic techniques that can be helpful in treating variceal bleed.