Skip to main content
SpringerLink
Log in

Management of Gastric Varices

  • Portal Hypertension (JC Garcia-Pagán, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Gastric varices (GV) present a challenge not always amenable to conventional approaches applied to esophageal varices (EV). Several types of GV classification systems exist including the familiar Sarin system and lesser-known vascular classifications which provide a foundation for management triage. While GV bleeding is less frequent than EV bleeding, it is often more pronounced. Initial management follows that for EV including very cautious volume replacement and early use of vasoactive medications. Urgent temporizing measures, if needed, may include balloon tamponade, sclerosants, banding, clipping and possibly procoagulants. Imaging is important in early management as optimal modalities such as balloon retrograde transvenous obliteration (BRTO), transhepatic porto-systemic shunts (TIPS), cyanoacrylate or combination modalities are contingent on the underlying vascular anatomy. Each of these is associated with particular advantages and disadvantages as discussed below.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sarin SK et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343–9.

    Article  CAS  PubMed  Google Scholar 

  2. Mumtaz K et al. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding. World J Gastroenterol. 2007;13(8):1247–51.

    Article  CAS  PubMed  Google Scholar 

  3. Sarin SK, Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol. 1989;84(10):1244–9.

    CAS  PubMed  Google Scholar 

  4. Kim T et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25(2):307–12.

    Article  CAS  PubMed  Google Scholar 

  5. Akiyoshi N et al. The natural history and prognostic factors in patients with cirrhosis and gastric fundal varices without prior bleeding. Hepatol Res. 2000;17(2):145–55.

    Article  PubMed  Google Scholar 

  6. Mishra SR et al. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol. 2011;54(6):1161–7.

    Article  CAS  PubMed  Google Scholar 

  7. Kang EJ et al. Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices. World J Gastroenterol. 2011;17(11):1494–500.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Chang CJ et al. Risk factors of early re-bleeding and mortality in patients with ruptured gastric varices and concomitant hepatocellular carcinoma. J Gastroenterol. 2012;47(5):531–9.

    Article  PubMed  Google Scholar 

  9. Jang SY et al. Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study. Clin Mol Hepatol. 2012;18(4):368–74.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc. 1986;32(4):264–8.

    Article  CAS  PubMed  Google Scholar 

  11. Kiyosue H et al. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. Radiographics. 2013;33(1):87–100.

    Article  PubMed  Google Scholar 

  12. Caldwell SH et al. Enbucrilate for gastric varices: extended experience in 92 patients. Aliment Pharmacol Ther. 2007;26(1):49–59.

    Article  CAS  PubMed  Google Scholar 

  13. Agarwal AK et al. Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg. 2008;196(2):149–54.

    Article  PubMed  Google Scholar 

  14. Heider TR et al. The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg. 2004;239(6):876–80. discussion 880-2.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Saad WE. Vascular anatomy and the morphologic and hemodynamic classifications of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure. Tech Vasc Interv Radiol. 2013;16(2):60–100. Very good description of the vascular anatomy and classification systems pertinent to the BRTO procesdure. The review article provides an in depth description of appropriate management options based on vascular anatomy.

    Article  PubMed  Google Scholar 

  16. Khanna R, Sarin SK. Non-cirrhotic portal hypertension - diagnosis and management. J Hepatol. 2013. doi:10.1016/j.jhep.2013.08.013.

    PubMed  Google Scholar 

  17. El Atti EA et al. Variceal pressure is a strong predictor of variceal haemorrhage in patients with cirrhosis as well as in patients with non-cirrhotic portal hypertension. Gut. 1999;45(4):618–21.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Spaander VM, van Buuren HR, Janssen HL. Review article: the management of non-cirrhotic non-malignant portal vein thrombosis and concurrent portal hypertension in adults. Aliment Pharmacol Ther. 2007;26 Suppl 2:203–9.

    Article  PubMed  Google Scholar 

  19. Bilbao JI et al. Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol. 2004;27(5):474–80.

    PubMed  Google Scholar 

  20. Senzolo M et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Aliment Pharmacol Ther. 2006;23(6):767–75.

    Article  CAS  PubMed  Google Scholar 

  21. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175–89.

    Article  PubMed  Google Scholar 

  22. Senzolo M et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 2012;32(6):919–27.

    Article  CAS  PubMed  Google Scholar 

  23. Zocco MA et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol. 2009;51(4):682–9.

    Article  PubMed  Google Scholar 

  24. Amitrano L et al. Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology. 2000;31(2):345–8.

    Article  CAS  PubMed  Google Scholar 

  25. Mangia A et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors. Eur J Gastroenterol Hepatol. 2005;17(7):745–51.

    Article  CAS  PubMed  Google Scholar 

  26. Hong HJ et al. Comparison of endoscopic variceal ligation and endoscopic variceal obliteration in patients with GOV1 bleeding. Chonnam Med J. 2013;49(1):14–9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Tripathi D et al. The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations. Gut. 2002;51(2):270–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Arakawa M, Masuzaki T, Okuda K. Pathomorphology of esophageal and gastric varices. Semin Liver Dis. 2002;22(1):73–82.

    Article  PubMed  Google Scholar 

  29. Arakawa M, Masuzaki T, Okuda K. Pathology of fundic varices of the stomach and rupture. J Gastroenterol Hepatol. 2002;17(10):1064–9.

    Article  PubMed  Google Scholar 

  30. Kiyosue H et al. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics. 2003;23(4):911–20.

    Article  PubMed  Google Scholar 

  31. Kiyosue H et al. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features. Radiographics. 2003;23(4):921–37. discussion 937.

    Article  PubMed  Google Scholar 

  32. Hirota S et al. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211(2):349–56.

    Article  CAS  PubMed  Google Scholar 

  33. Maruyama H et al. Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding. Eur J Radiol. 2010;75(1):e41–5.

    Article  PubMed  Google Scholar 

  34. Caldwell S. Gastric varices: is there a role for endoscopic cyanoacrylates, or are we entering the BRTO era? Am J Gastroenterol. 2012;107(12):1784–90.

    Article  PubMed  Google Scholar 

  35. Lo GH et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33(5):1060–4.

    Article  CAS  PubMed  Google Scholar 

  36. Tan PC et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43(4):690–7.

    Article  PubMed  Google Scholar 

  37. Oho K et al. Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy. 1995;27(5):349–54.

    Article  CAS  PubMed  Google Scholar 

  38. Sarin SK et al. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97(4):1010–5.

    Article  CAS  PubMed  Google Scholar 

  39. Gimson AE, Westaby D, Williams R. Endoscopic sclerotherapy in the management of gastric variceal haemorrhage. J Hepatol. 1991;13(3):274–8.

    Article  CAS  PubMed  Google Scholar 

  40. Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc. 1997;46(1):8–14.

    Article  CAS  PubMed  Google Scholar 

  41. Sarin SK et al. Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg. 1988;75(8):747–50.

    Article  CAS  PubMed  Google Scholar 

  42. Arantes V, Albuquerque W. Fundal variceal hemorrhage treated by endoscopic clip. Gastrointest Endosc. 2005;61(6):732.

    Article  PubMed  Google Scholar 

  43. Holster IL et al. Controlling gastric variceal bleeding with endoscopically applied hemostatic powder (Hemospray). J Hepatol. 2012;57(6):1397–8.

    Article  PubMed  Google Scholar 

  44. Datta D et al. Use of fibrin glue (beriplast) in the management of bleeding gastric varices. Endoscopy. 2003;35(8):675–8.

    Article  CAS  PubMed  Google Scholar 

  45. Heneghan MA, Byrne A, Harrison PM. An open pilot study of the effects of a human fibrin glue for endoscopic treatment of patients with acute bleeding from gastric varices. Gastrointest Endosc. 2002;56(3):422–6.

    Article  PubMed  Google Scholar 

  46. Yang WL et al. Endoscopic use of human thrombin in bleeding gastric varices. Am J Gastroenterol. 2002;97(6):1381–5.

    Article  CAS  PubMed  Google Scholar 

  47. Lo GH et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39(8):679–85.

    Article  PubMed  Google Scholar 

  48. Sanyal AJ et al. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology. 1997;112(3):889–98.

    Article  CAS  PubMed  Google Scholar 

  49. Saad WE, Darcy MD. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Semin Interv Radiol. 2011;28(3):339–49. Good article reviewing existing literature on the TIPS and BRTO procedures. The authors comment on the merits/pitfalls of both procedures and point out that success is dependent on variability in portal flow that is diverted.

    Article  Google Scholar 

  50. Soehendra N et al. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18(1):25–6.

    Article  CAS  PubMed  Google Scholar 

  51. Rajoriya N et al. Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding. QJM. 2011;104(1):41–7.

    Article  CAS  PubMed  Google Scholar 

  52. Wang YM et al. Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding. World J Gastroenterol. 2009;15(39):4945–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Greenwald BD et al. N-2-butyl-cyanoacrylate for bleeding gastric varices: a United States pilot study and cost analysis. Am J Gastroenterol. 2003;98(9):1982–8.

    Article  CAS  PubMed  Google Scholar 

  54. Mahadeva S et al. Cost-effectiveness of N-butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding. Am J Gastroenterol. 2003;98(12):2688–93.

    Article  CAS  PubMed  Google Scholar 

  55. Procaccini NJ et al. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009;70(5):881–7.

    Article  PubMed  Google Scholar 

  56. Prachayakul V et al. Factors influencing clinical outcomes of Histoacryl(R) glue injection-treated gastric variceal hemorrhage. World J Gastroenterol. 2013;19(15):2379–87.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Kazi S, Spanger M, Lubel J. Education and imaging: gastrointestinal: pulmonary embolism of cyanoacrylate glue following endoscopic injection of gastric varices. J Gastroenterol Hepatol. 2012;27(12):1874.

    Article  CAS  PubMed  Google Scholar 

  58. Cheng PN et al. Splenic infarction after histoacryl injection for bleeding gastric varices. Gastrointest Endosc. 1998;48(4):426–7.

    Article  CAS  PubMed  Google Scholar 

  59. Liu CH et al. Splenic vein thrombosis and Klebsiella pneumoniae septicemia after endoscopic gastric variceal obturation therapy with N-butyl-2-cyanoacrylate. Gastrointest Endosc. 2006;63(2):336–8.

    Article  PubMed  Google Scholar 

  60. Lee GH et al. Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer. Endoscopy. 2000;32(5):422–4.

    Article  CAS  PubMed  Google Scholar 

  61. Seewald S et al. A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos). Gastrointest Endosc. 2008;68(3):447–54.

    Article  PubMed  Google Scholar 

  62. Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices: concept, basic techniques, and outcomes. Semin Interv Radiol. 2012;29(2):118–28.

    Article  Google Scholar 

  63. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001;12(3):327–36.

    Article  CAS  PubMed  Google Scholar 

  64. Kitamoto M et al. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol. 2002;178(5):1167–74.

    Article  PubMed  Google Scholar 

  65. Watanabe M et al. Short-term effects and early complications of balloon-occluded retrograde transvenous obliteration for gastric varices. ISRN Gastroenterol. 2012;2012:919371. Retrospective review of short-term effects and complications in 77 patients following BRTO based on CT and gastroscopy. The frequencies of exacebration of ascites, pleural effusion, and EVs after BRTO were high but survival was depndent on Child-Pugh class and concomitance of HCC.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Tanihata H et al. Changes in portal systemic pressure gradient after balloon-occluded retrograde transvenous obliteration of gastric varices and aggravation of esophageal varices. Cardiovasc Intervent Radiol. 2009;32(6):1209–16.

    Article  PubMed  Google Scholar 

  67. Araki T, Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices from unconventional systemic veins in the absence of gastrorenal shunts. Tech Vasc Interv Radiol. 2012;15(3):241–53. Article describing anatomy, techniques and results of BRTO via unconventional (non-GRS) portosystemic venous routes.

    Article  PubMed  Google Scholar 

  68. Yamagami T et al. Successful balloon-occluded retrograde transvenous obliteration of gastric varix via pericardiacophrenic vein after embolization of portopulmonary venous anastomosis. J Vasc Interv Radiol. 2013;24(1):137–9.

    Article  PubMed  Google Scholar 

  69. Dadabhai AS et al. Balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices. Hepatology. 2012;55(4):1301–4.

    Article  PubMed  Google Scholar 

  70. Kawanaka H. Balloon-occluded retrograde transvenous obliteration: one step beyond obliteration of gastric varices. J Gastroenterol Hepatol. 2012;27(1):3–4.

    Article  PubMed  Google Scholar 

  71. Saad WE et al. The effect of balloon-occluded transvenous obliteration of gastric varices and gastrorenal shunts on the hepatic synthetic function: a comparison between child-pugh and model for end-stage liver disease scores. Vasc Endovascular Surg. 2013;47(4):281–7. Retrospective study of patients without TIPS pre and post BRTO with repsect to their MELD score. BRTO was noted to have a positive effect on hepatic synthetic function from 1.5 to 4 months following the procedure. MELD score significantly improved 4 months post BRTO.

    Article  PubMed  Google Scholar 

  72. Uehara H et al. Prediction of improved liver function after balloon-occluded retrograde transvenous obliteration: relation to hepatic vein pressure gradient. J Gastroenterol Hepatol. 2012;27(1):137–41.

    Article  PubMed  Google Scholar 

  73. Kumamoto M et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol. 2010;25(6):1129–35.

    Article  PubMed  Google Scholar 

  74. Patel A, Fischman AM, Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices. AJR Am J Roentgenol. 2012;199(4):721–9.

    Article  PubMed  Google Scholar 

  75. Saad WE et al. Balloon-occlusion catheter rupture during balloon-occluded retrograde transvenous obliteration of gastric varices utilizing sodium tetradecyl sulfate: incidence and consequences. Vasc Endovascular Surg. 2012;46(8):664–70.

    Article  PubMed  Google Scholar 

  76. Cho SK et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol. 2007;189(6):W365–72.

    Article  PubMed  Google Scholar 

  77. Saad WE, Kitanosono T, Koizumi J. Balloon-occluded antegrade transvenous obliteration with or without balloon-occluded retrograde transvenous obliteration for the management of gastric varices: concept and technical applications. Tech Vasc Interv Radiol. 2012;15(3):203–25. Article describing the clinical and technical applications, consideration and outcaomes of BATO. The authros provide a detailed description of anatomy and clinical factors amenable to BRTO, BATA or a combined approach.

    Article  PubMed  Google Scholar 

  78. Kawai N et al. Percutaneous transportal outflow-vessel-occluded sclerotherapy for gastric varices unmanageable by balloon-occluded retrograde transvenous obliteration. Hepatol Res. 2013;43(4):430–5.

    Article  PubMed  Google Scholar 

  79. Wang J et al. Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding. World J Gastroenterol. 2013;19(5):706–14.

    Article  PubMed Central  PubMed  Google Scholar 

  80. Imazu H et al. Balloon catheter-assisted endoscopic sclerotherapy for gastric fundal varices using alpha-cyanoacrylate monomer. J Clin Gastroenterol. 2001;33(1):49–52.

    Article  CAS  PubMed  Google Scholar 

  81. Rao AS et al. Combined endoscopic-interventional radiologic approach for the treatment of bleeding gastric varices in the setting of a large splenorenal shunt. Gastrointest Endosc. 2012;76(5):1064–5. First report of combined endoscopic CA injection and balloon occlusion of a SRS to minimize glue embolism. This technique enhances stasis of blood and resultant polymerization of glue within the GV.

    Article  PubMed  Google Scholar 

  82. Imai Y, et al. Balloon-occluded retrograde transvenous obliteration using a microballoon catheter for intractable gastric fundal varices. J Gastroenterol Hepatol. 2014;29(2):365–71.

  83. Saad WE, Nicholson DB. Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques. Tech Vasc Interv Radiol. 2013;16(2):102–7.

    Article  Google Scholar 

  84. Gwon DI et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration–a primary report. Radiology. 2013;268(1):281–7.

    Article  PubMed  Google Scholar 

  85. Romero-Castro R, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013. Retrospective multicenter analysis of EUS-guided coil application vs CA injection. EUS guided coil embolization required fewer procedures for GV obturation and tended to have fewer complications. However, the authors suggest that CA injection is technically less demanding.

  86. Koizumi J et al. Carbon dioxide (CO2) vs iodinated contrast digital subtraction angiography during balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerosant for gastric varices. J Vasc Interv Radiol. 2012;23(11):1453–1459 e1.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dushant Uppal, Zachary Henry, Stephen Caldwell, and Abdullah Al-Osaimi declare that they have no conflicts of interest. Wael Saad reports grants and/or personal fees from Seimens, Germany, Merit Medical, Boston Scientific, and Atrium Medical, outside of the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Virginia Healthsystem, PO Box 800708, Charlottesville, VA, 22908-0708, USA

    Dushant Uppal, Zachary Henry, Abdullah Al-Osaimi, Wael Saad & Stephen Caldwell

Authors
  1. Dushant Uppal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zachary Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdullah Al-Osaimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wael Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen Caldwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen Caldwell.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uppal, D., Henry, Z., Al-Osaimi, A. et al. Management of Gastric Varices. Curr Hepatology Rep 13, 208–217 (2014). https://doi.org/10.1007/s11901-014-0232-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-014-0232-8

Keywords

Search

Navigation