title: Management of acute gastric varices bleeding.
abstract: Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs) occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV) bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10-30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
authors.forename: Chen-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.forename: Ping-Hsien
authors.initials: PH
authors.lastname: Chen
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D021721:Balloon Occlusion; D004932:Esophageal and Gastric Varices / Q000145:classification / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods; D013917:Thrombin / Q000627:therapeutic use
chemical_list: D013917:Thrombin
keywords: balloon-occluded retrograde transvenous obliteration; cyanoacrylate; gastric varices; portal hypertension; thrombin; transjugular intrahepatic portosystemic shunts