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Semin intervent Radiol 2011; 28(3): 273-282
DOI: 10.1055/s-0031-1284453
© Thieme Medical Publishers

Medical and Endoscopic Management of Gastric Varices

Abdullah M. S. Al-Osaimi1 , Stephen H. Caldwell1
  • 1Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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Publication History

Publication Date:
15 August 2011 (online)

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ABSTRACT

In the past 20 years, our understanding of the pathophysiology and management options among patients with gastric varices (GV) has changed significantly. GV are the most common cause of upper gastrointestinal bleeding in patients with portal hypertension after esophageal varices (EV) and generally have more severe bleeding than EV. In the United States, the majority of GV patients have underlying portal hypertension rather than splenic vein thrombosis. The widely used classifications are the Sarin Endoscopic Classification and the Japanese Vascular Classifications. The former is based on the endoscopic appearance and location of the varices, while the Japanese classification is based on the underlying vascular anatomy. In this article, the authors address the current concepts of classification, epidemiology, pathophysiology, and emerging management options of gastric varices. They describe the stepwise approach to patients with gastric varices, including the different available modalities, and the pearls, pitfalls, and stop-gap measures useful in managing patients with gastric variceal bleed.

KEYWORDS

Gastric varices - portal hypertension - liver cirrhosis - BRTO - TIPS - splenorenal shunt - cyanoacrylate

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Abdullah M. S. Al-OsaimiM.D. F.A.C.P. F.A.C.G. A.G.A.F. 

Associate Professor of Medicine and Surgery, Medical Director of Liver Transplantation, Division of Gastroenterology and Hepatology, Deparment of Medicine, University of Virginia Health System

P.O. Box 800708, Charlottesville, VA 22908-0708

Email: aa6h@virginia.edu