title: Management of gastric varices: a French national survey.
abstract: OBJECTIVE
  Bleeding from gastric varices is more severe than that from esophageal varices, but its management remains debated. We aimed to determine how French hepatogastroenterologists manage cirrhotic patients with gastric varices.
  
  
  METHODS
  Hepatogastroenterologists (n=1163) working in general or university hospitals received a self-administered questionnaire.
  
  
  RESULTS
  Overall, 155 hepatogastroenterologists (13.3%) from 112 centers (33.3%; 39/40 university hospitals, 73/296 general hospitals) answered. Primary prophylaxis was used by 98.1% of hepatogastroenterologists as follows: β-blockers 96.1% (93.8 vs. 97.0%; university vs. general hospitals respectively; P=0.57), glue obliteration 16.9% (17.2 vs. 16.3%; P=0.88), and transjugular intrahepatic portosystemic shunt (TIPS) 8.0% (12.7 vs. 4.6%; P=0.12). To manage bleeding, university hospitals had greater local access to glue obliteration (95.4 vs. 68.2%; P<0.001) and TIPS (78.5 vs. 3.5%; P<0.001). Early TIPS was proposed by 53.6% (72.1 vs. 39.2%; P<0.001). Glue obliteration was performed under general anesthesia (86.1%) using Glubran (43.1%) or Histoacryl (52.9%), and lipiodol (78.8%) with varying degrees of dilution (1 : 10 to 3 : 4). The injected volume per varix varied widely (1-20 ml). Glue obliteration, band ligation, or both were used by, respectively, 64.2, 18.2, and 17.5% of practitioners. Almost all hepatogastroenterologists (98%) performed secondary prophylaxis: β-blockers 74.7% (75.0 vs. 74.4%, university vs. general hospitals; P=0.93), glue obliteration 66.0% (76.9 vs. 57.6%; P=0.013), and TIPS 30.0% (39.1 vs. 23.3%; P=0.037).
  
  
  CONCLUSIONS
  The management of gastric varices in France is heterogeneous across centers. University hospitals have better access to techniques such as glue obliteration and TIPS. As bleeding from gastric varices has a poor outcome, guidelines should be established to standardize clinical practices and design further studies.
authors: aDepartment of Hepatology, University Hospital of Besançon, Besançon bDepartment of Hepato-Gastroenterology, Purpan Hospital, Toulouse cDepartment of Hepato-Gastroenterology, La Pitié-Salpêtrière Hospital dDepartment of Hepato-Gastroenterology, Saint-Antoine Hospital, Paris eDepartment of Hepatology, Inserm U-773, Beaujon Hospital, Clichy fDepartment of Hepato-Gastroenterology, Inserm U-1075, Caen Hospital, Caen gDepartment of Hepato-Gastroenterology, Gonesse Hospital, Gonesse hDepartment of Hepatology, Saint-Joseph Hospital, Marseille iDepartment of Hepato-Gastroenterology, Angers Hospital, Angers, France.
authors: Delphine
authors: D
authors: Weil
authors: Jean-Paul
authors: JP
authors: Cervoni
authors: Nadim
authors: N
authors: Fares
authors: Marika
authors: M
authors: Rudler
authors: Christophe
authors: C
authors: Bureau
authors: Aurélie
authors: A
authors: Plessier
authors: Thong
authors: T
authors: Dao
authors: Arnaud
authors: A
authors: Pauwels
authors: Dominique
authors: D
authors: Thabut
authors: Paul
authors: P
authors: Castellani
authors: Frederic
authors: F
authors: Oberti
authors: Nicolas
authors: N
authors: Carbonell
authors: Laure
authors: L
authors: Elkrief
authors: Vincent
authors: V
authors: Di Martino
authors: Thierry
authors: T
authors: Thevenot
mesh_terms: D000328:Adult; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends*; D016558:Hemostasis, Endoscopic / Q000639:trends; D006489:Hemostatic Techniques / Q000639:trends*; D006490:Hemostatics / Q000627:therapeutic use; D006769:Hospitals, General / Q000639:trends; D006785:Hospitals, University / Q000639:trends; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D014014:Tissue Adhesives