Endoscopic management of gastric variceal bleeding

Gastroenterol Clin North Am. 2014 Dec;43(4):807-18. doi: 10.1016/j.gtc.2014.08.010. Epub 2014 Sep 12.

Abstract

Expert knowledge of endoscopic management of gastric varices is essential, as these occur in 20% of patients with portal hypertension. Bleeding is relatively uncommon, but carries significant mortality when this occurs. Inability to directly target intravascular injections and the potential complication related to glue embolization has resulted in the development of novel techniques. Direct visualization of the varix lumen using endoscopic ultrasound (EUS) allows targeted therapy of feeder vessels with real-time imaging. EUS-guided combination therapy with endovascular coiling and cyanoacrylate injections promise to provide reduced complication rates, increased obliteration of varices, and reduced long-term rebleeding rates.

Keywords: Coil embolization; Cyanoacrylate; Endoscopic ultrasound; Gastric varices.

Publication types

  • Review

MeSH terms

  • Adhesives / administration & dosage
  • Balloon Occlusion*
  • Cyanoacrylates / administration & dosage
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods*
  • Endoscopy, Gastrointestinal
  • Endosonography
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / therapy*
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Hemostasis, Endoscopic / methods*
  • Humans
  • Ultrasonography, Interventional

Substances

  • Adhesives
  • Cyanoacrylates