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Traitement endoscopique des varices gastriques

Endoscopic treatment of gastric varices

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  • Published:
Acta Endoscopica

Résumé

Le saignement par rupture de varice gastrique est un événement rare et grave, sa prise en charge doit être multidisciplinaire et implique une bonne connaissance du réseau vasculaire. Le seul traitement endoscopique reconnu à ce jour et recommandé est l’obturation par cyanoacrylate. Ce traitement efficace est tout de même imparfait avec 5 à 10 % de récidives et des complications graves, voire fatales. De nouvelles modalités thérapeutiques comme l’échoendoscopie thérapeutique vasculaire sont venues enrichir l’arsenal thérapeutique avec l’injection de coils et ou de cyanoacrylate dans les perforantes ou dans les varices gastriques avec de très bons résultats. Faute d’études randomisées, ce type de traitement n’apparaît pas encore dans les recommandations. Seul l’avenir prouvera que les nouveaux traitements endoscopiques ne sont pas que de la poudre aux yeux. Les radiologues ne sont jamais très loin des endoscopistes et heureusement car le transjugular intrahepatic portosystemic shunt (TIPS) est une alternative de premier choix au traitement endoscopique qui doit toujours être envisagée, surtout chez les patients à risque.

Abstract

Gastric variceal bleeding is a challenge with worst outcomes than oesphageal variceal. The management needs pluridisciplinary discussions and correct appreciation of vascular portal hypertension shunts. Current guidelines recommend endoscopic therapy as first-line with cyanoacrylate obturation. This effective therapy is not perfect with up to 5 to 10% of rebleeding and serious complications. Recent therapies as ultrasound vascular interventional endoscopy with coils or cyano-acrylate guided injection appears as a really promising weapon. Without randomized and controlled studies, this endoscopic technic can’t appear in current guidelines. Future will show that recent endoscopic therapies are not just smokescreen. Interventional radiologists have come to the rescue of many endoscopists when managing bleeding varices. Transjugular intrahepatic portosystemic shunt is indeed effective in the prevention of gastric variceal rebleeding especially for high risk patients.

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  1. Service des maladies du foie et de l’appareil digestif, CHU d’Angers, 4 rue Larrey, F-49933, Angers cedex, France

    E. Cesbron-Métivier

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  1. E. Cesbron-Métivier
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Correspondence to E. Cesbron-Métivier.

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Cesbron-Métivier, E. Traitement endoscopique des varices gastriques. Acta Endosc 44, 171–179 (2014). https://doi.org/10.1007/s10190-014-0392-y

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  • DOI: https://doi.org/10.1007/s10190-014-0392-y

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