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Management of Gastric and Ectopic Varices

  • Portal Hypertension and Liver Transplantation (AK Singal, Section Editor)
  • Published:
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Abstract

Purpose of Review

Gastric varices (GV) are seen commonly in patients with portal hypertension and esophageal varices, more so in variceal bleeders. Compared to esophageal varices, there is limited data on the management of GV and ectopic varices. The current review provides a practical and updated approach for the management of patients with GV and ectopic varices.

Recent Findings

The management of isolated gastric varices (IGV) and esophageal varices continuing on the greater curvature of the stomach, the gastro-esophageal varices type 2 (GOV2) has improved significantly. Control of active bleed or prevention of rebleeding from these varices can be achieved by obturating them using endoscopic cyanoacrylate (CYA) glue injection in the majority of cases with or without the addition of beta-blocker therapy. Endoscopic ultrasound-guided coil (with/without CYA glue) injection and endovascular approaches such as transjugular intrahepatic porto-systemic shunt (TIPS) and balloon-occluded/plug-assisted retrograde transvenous occlusion (BRTO/PARTO) alone or in combination are helpful in difficult cases or uncontrolled bleeding. Similarly, in ectopic variceal bleeding, apart from endotherapy with band ligation, sclerotherapy or cyanoacrylate glue injection, TIPS and BRTO are effective approaches in difficult-to-access sites.

Summary

Multiple treatment options are now available for GV and ectopic variceal bleed involving endoscopic and endovascular approaches. Depending upon their anatomy, management of bleeding involves careful selection out of these options.

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  1. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

    Chitranshu Vashishtha & Shiv Kumar Sarin

  2. Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India, Pin-110070

    Shiv Kumar Sarin

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Vashishtha, C., Sarin, S.K. Management of Gastric and Ectopic Varices. Curr Hepatology Rep 22, 33–43 (2023). https://doi.org/10.1007/s11901-023-00597-5

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