Pathophysiological management of gastric varices: From hemodynamics to targeted therapies

doi:10.4291/wjgp.122115

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World Journal of Gastrointestinal Pathophysiology

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2150-5330

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pathophysiol. Sep 22, 2026; 17(3): 122115
Published online Sep 22, 2026. doi: 10.4291/wjgp.122115

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Figure 1 Anatomy of gastric fundal varices based on various afferent (inflow) and efferent (outflow) pathways. GV: Gastric varice; PV: Portal vein; LGV: Left gastric vein; PGV: Posterior gastric vein; SGV: Short gastric veins; GRS: Gastrorenal shunt; GCS: Gastrocaval shunt; IVC: Inferior vena cava; SMV: Superior mesenteric vein; LRV: Left renal vein; SV: Splenic vein.

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Figure 2 Sarin classification of gastric varices. A: Gastroesophageal varices type 1; B: Gastroesophageal varices type 2; C: Isolated gastric varices type 1; D: Isolated gastric varices type 2. GOV1: Gastroesophageal varices type 1; GOV2: Gastroesophageal varices type 2; IGV1: Isolated gastric varices type 1; IGV2: Isolated gastric varices type 2; LGV: Left gastric vein; PGV: Posterior gastric vein; SGV: Short gastric veins; GEV: Gastroepiploic vein.

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Figure 3 Kiyosue classification of gastric varices. A: Classification based on efferent pathways: Type 1 (single afferent vein), type 2 (multiple afferent veins), and type 3 (indirect inflow through collateral networks); B: Afferent pathways: Type A (single draining shunt, usually gastrorenal), type B (single shunt with collateral veins), type C (multiple draining shunts), and type D (absence of a major shunt with drainage through small collaterals).

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Figure 4 Approach to the management of gastric fundal varices based on the hemodynamics, along with clinical modifiers. ¹Trans-transjugular intrahepatic portosystemic shunt (TIPS)/balloon-occluded antegrade transvenous obliteration/percutaneous transhepatic obliteration preferred over TIPS for Kiyosue C. GOV1: Gastroesophageal varices type 1; GOV2: Gastroesophageal varices type 2; IGV1: Isolated gastric varices type 1; IGV2: Isolated gastric varices type 2; EVL: Endoscopic variceal ligation; EUS: Endoscopic ultrasound; ECI: Endoscopic cyanoacrylate injection; BRTO: Balloon-occluded retrograde transvenous obliteration; PARTO: Plug-assisted retrograde transvenous obliteration; CARTO: Coil-assisted retrograde transvenous obliteration; RTO: Retrograde transvenous obliteration; BATO: Balloon-occluded antegrade transvenous obliteration; PTO: Percutaneous transhepatic obliteration; SAE: Splenic artery embolization; PTA: Percutaneous transluminal angioplasty; CT: Computed tomography; MRI: Magnetic resonance imaging; TIPS: Transjugular intrahepatic portosystemic shunt.

Citation: Giri S, Patel RK, Tripathy TP, Praharaj DL, Chavan R. Pathophysiological management of gastric varices: From hemodynamics to targeted therapies. World J Gastrointest Pathophysiol 2026; 17(3): 122115
URL: https://www.wjgnet.com/2150-5330/full/v17/i3/122115.htm
DOI: https://dx.doi.org/10.4291/wjgp.122115

Giri S, Patel RK, Tripathy TP, Praharaj DL, Chavan R. Pathophysiological management of gastric varices: From hemodynamics to targeted therapies. World J Gastrointest Pathophysiol 2026; 17(3): 122115 [DOI: 10.4291/wjgp.122115]

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