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World J Hepatol. Mar 27, 2014; 6(3): 130-136
Published online Mar 27, 2014. doi: 10.4254/wjh.v6.i3.130
Management of gastric variceal bleeding: Role of endoscopy and endoscopic ultrasound
Mohit Girotra, Saikiran Raghavapuram, Rtika R Abraham, Mrinal Pahwa, Archna R Pahwa, Rayburn F Rego
Mohit Girotra, Rayburn F Rego, Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72202, United States
Saikiran Raghavapuram, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72202, United States
Rtika R Abraham, Department of Geriatrics, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72202, United States
Mrinal Pahwa, Department of Surgery, Sir Ganga Ram Hospital, New Delhi 110060, India
Archna R Pahwa, Department of Pathology, Lady Hardinge Medical College (LHMC), New Delhi 110001, India
Author contributions: All authors contributed to this work.
Correspondence to: Mohit Girotra, MD, Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), 4301 W. Markham Street, Shorey S8-68, Mailslot # 567, Little Rock, AR 72202, United States. mgirotra@uams.edu
Telephone: +1-501-6865175 Fax: +1-501-6866248
Received: October 29, 2013
Revised: February 11, 2014
Accepted: February 16, 2014
Published online: March 27, 2014
Processing time: 141 Days and 10.2 Hours
Abstract

Gastric varices (GVs) are notorious to bleed massively and often difficult to manage with conventional techniques. This mini-review addresses endoscopic management principles for gastric variceal bleeding, including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration. The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis, improved classification, innovative management strategies and confirmatory tool for eradication of GVs.

Keywords: Gastric; Varices; Endoscopy; Ligation; Sclerotherapy; Management; Transjugular intrahepatic portosystemic shunt; Endoscopic ultrasound; Balloon-occluded retrograde transvenous obliteration; Endoscopic variceal obliteration

Core tip: This mini-review addresses endoscopic management principles for gastric variceal bleeding. Endoscopic variceal obliteration (EVO) with tissue adhesives is the currently accepted strategy for controlling bleeding and eradicating gastric varices (GVs). EVO is deemed better than both variceal ligation and sclerotherapy in randomized controlled trials. One unsettled issue with EVO is if routine reinjection is better than reinjection in case of rebleeding. The experience with combination treatments is still premature. For secondary prophylaxis, EVO, transjugular intrahepatic portosystemic shunt or beta-blocker use is recommended. Emerging use of EUS provides optimism of better diagnosis, improved classification, innovative management strategies and confirmatory tool for eradication of GVs.