Clin Endosc.  2019 Sep;52(5):407-415. 10.5946/ce.2019.178.

Endoscopic Therapy and Radiologic Intervention of Acute Gastroesophageal Variceal Bleeding

Affiliations
  • 1Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea. kbs9225@cu.ac.kr

Abstract

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.

Keyword

Esophageal and gastric varices; Hemorrhage; Endoscopy; Radiology; Interventional

MeSH Terms

Endoscopy
Esophageal and Gastric Varices*
Hemorrhage
Humans
Ligation
Liver Cirrhosis
Portasystemic Shunt, Surgical
Salvage Therapy
Varicose Veins
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