Korean J Radiol.  2012 Feb;13(Suppl 1):S40-S44. 10.3348/kjr.2012.13.S1.S40.

Practical Approach to Endoscopic Management for Bleeding Gastric Varices

• Lim YS

• KMID: 1372866
• DOI: http://doi.org/10.3348/kjr.2012.13.S1.S40

Abstract

Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.

Keyword

Endoscopic; Fundal; Gastric; Varix

MeSH Terms

Enbucrilate/*therapeutic use
Endoscopy, Gastrointestinal/*methods
Esophageal and Gastric Varices/*diagnosis/physiopathology/*therapy
Gastrointestinal Hemorrhage/*diagnosis/physiopathology/*therapy
Hemostasis, Endoscopic/*methods
Humans
Sclerotherapy/methods

Figure

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  Fig. 1 Classification of gastric varices. Adapted from Sarin (8).

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  Fig. 2 Strategic approach for endoscopic variceal obturation for large fundal varices. Intravariceal pressure at top of variceal dome (arrow) is highest leading to immediate extrusion of injected cyanoacrylate and massive uncontrollable bleeding. Thus, it is safer to first inject cyanoacrylate at side area of varix (arrowheads) where pressure is lower.

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