title: Endoscopic management of gastric variceal bleeding.
abstract: Expert knowledge of endoscopic management of gastric varices is essential, as these occur in 20% of patients with portal hypertension. Bleeding is relatively uncommon, but carries significant mortality when this occurs. Inability to directly target intravascular injections and the potential complication related to glue embolization has resulted in the development of novel techniques. Direct visualization of the varix lumen using endoscopic ultrasound (EUS) allows targeted therapy of feeder vessels with real-time imaging. EUS-guided combination therapy with endovascular coiling and cyanoacrylate injections promise to provide reduced complication rates, increased obliteration of varices, and reduced long-term rebleeding rates.
authors.affiliation: Department of Gastroenterology, Waikato Hospital, Pembroke Street, Hamilton 2001, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Weilert
authors.affiliation: Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, 6th Floor, San Francisco, CA 94115, USA. Electronic address: BinmoeK@sutterhealth.org.
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller
mesh_terms: D000269:Adhesives / Q000008:administration & dosage; D021721:Balloon Occlusion; D003487:Cyanoacrylates / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D018084:Ultrasonography, Interventional
chemical_list: D000269:Adhesives; D003487:Cyanoacrylates
keywords: Coil embolization; Cyanoacrylate; Endoscopic ultrasound; Gastric varices