title: Endoscopic treatment of gastric varices.
abstract: Gastric varices (GV) are present in one in 5 patients with portal hypertension and variceal bleeding. GV bleeds tend to be more severe with higher mortality. High index of suspicion, early detection and proper locational diagnosis are important. An algorithmic approach to the management of GV bleeding prevents rebleeds and improves survival. Vasoactive drugs should be started with in 30 minutes (door to needle time) and early endotherapy be done. Cyanoacrylate injection in experienced hands achieves hemostasis in >90% patients. A repeat session is sometimes needed for complete obturation of GV. Transjugular intrahepatic portosystemic shunt and balloon retrograde transvenous obliteration are effective rescue options. Secondary prophylaxis of GV bleeding is done with beta-blocker and endotherapy.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi 110010, India. Electronic address: shivsarin@gmail.com.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi 110010, India.
authors.forename: Awinash
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000465:Algorithms; D003487:Cyanoacrylates / Q000627:therapeutic use; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*
chemical_list: D000319:Adrenergic beta-Antagonists; D003487:Cyanoacrylates
keywords: Combined endoscopic therapy; EUS-guided therapy; Gastric variceal band ligation; Gastric variceal obturation; Gastric variceal sclerotherapy; Portal hypertension; Thrombin injection