Unpacking the challenge of gastric varices: A review on indication, timing and modality of therapy

Abstract

Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal hypertension. Despite the emergence of a number of novel endoscopic and radiologic therapies for oesophagogastric varices, controversy exists regarding the indication, timing and modality of therapy. The aim of this review is to provide a concise and practical evidence-based overview of these issues.

Keywords: Upper gastrointestinal bleeding; Portal hypertension; Gastric varices; Variceal band ligation; Variceal obliteration; Sclerotherapy; Transjugular intrahepatic portosystemic shunt; Balloon-occlusion retrograde transvenous obliteration

Core Tip: Gastric varices are an uncommon source of bleeding in patients with portal hypertension. Although evidence supports acute bleeding treatment and secondary prophylaxis using interventional endoscopy or radiology, there is still lack of data to support primary prophylaxis for all patients. If treatment is required, both interventional endoscopy and radiological approaches should be considered. Interventional endoscopy using endoscopic ultrasound-guided combination coil and cyanoacrylate obliteration appears to be the optimal approach based on the current literature.