Hemostasis of Acute Gastric Variceal Bleeding

  • Chris Hamerski
  • Kenneth F. Binmoeller
  • Janak N. ShahEmail author


Gastric variceal hemorrhage is one of the most dreaded endoscopic emergencies. Optimal management recommendations are limited by the lack of robust evidence-based data. Although endoscopic band ligation and sclerotherapy are effective modalities for esophageal variceal bleeding, they are suboptimal therapies for fundal variceal hemorrhage. Endoscopic cyanoacrylate injection is considered a first-line treatment option, where available. The role of EUS-guided angiotherapy for gastric variceal bleeding is promising. Non-endoscopic treatment options include transjugular intrahepatic portosystemic shunt and balloon-occluded retrograde transvenous obliteration. There is a need for prospective comparative studies among the various treatment modalities to further define optimal management algorithms for gastric variceal hemorrhage.

This chapter includes supplementary videos.


Gastric varices Gastric variceal bleeding Endoscopic band ligation Sclerotherapy Cyanoacrylate injection EUS Transjugular intrahepatic portosystemic shunt Balloon-occluded retrograde transvenous obliteration 

Supplementary material

Video 13.1

Endoscopic band ligation for bleeding gastroesophageal varices type 1 (GOV1) (MP4 22524 kb)

Video 13.2

Technique of 2-octyl cyanoacrylate injection for fundal varices with stigmata of recent bleeding (MP4 21226 kb)

Video 13.3

Actively bleeding fundal varix treated with cyanoacrylate injection (MP4 7390 kb)

Video 13.4

Animation of balloon-occluded retrograde transvenous obliteration (BRTO) procedure for treatment of gastric varices (MP4 6488 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Chris Hamerski
    • 1
  • Kenneth F. Binmoeller
    • 1
  • Janak N. Shah
    • 1
    Email author
  1. 1.Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical CenterSan FranciscoUSA

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