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Gastric Varices and Ectopic Varices

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Portal Hypertension VII
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Abstract

Acute bleeding from gastric and ectopic varices is a major complication of portal hypertension. Currently, treatment options for the management of GV include beta-blockers, endoscopic band ligation, endoscopic cyanoacrylate injection, transjugular intrahepatic portosystemic shunts, and balloon-occluded retrograde transvenous obliteration. Owing to the heterogeneity of these varices, management options are variable. The proper treatment requires appropriate endoscopic and imaging evaluation by a multidisciplinary team. This chapter will review the hemodynamic features of gastric and ectopic varices and current endovascular management options.

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References

  1. Garcia-Tsao G, Abraldes J, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis and management—2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65(1):310–35. https://doi.org/10.1002/hep.28906.

    Article  PubMed  Google Scholar 

  2. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343–9.

    Article  CAS  Google Scholar 

  3. Luo X, Nie L, Wang Z, Tsauo J, Tang C, Li X. Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding. Cardiovasc Intervent Radiol. 2014;37(1):108–13.

    Article  Google Scholar 

  4. Kiyosue H, Ibukuro K, Maruno M, Tanoue S, Hongo N, Mori H. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. Radiographics. 2013;33(1):87–100.

    Article  Google Scholar 

  5. Tripathi D, Therapondos G, Jackson E, Redhead DN, Hayes PC. The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations. Gut. 2002;51(2):270–4.

    Article  CAS  Google Scholar 

  6. Garcia-Pagan JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370–9.

    Article  CAS  Google Scholar 

  7. Yu J, Wang X, Jiang M, Ma H, Zhou Z, Yang L, et al. Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study. Eur Radiol. 2019;29(2):699–706.

    Article  Google Scholar 

  8. Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. AJR Am J Roentgenol. 1984;143(3):627–8.

    Article  CAS  Google Scholar 

  9. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11(1):51–8.

    Article  CAS  Google Scholar 

  10. Mukund A, Rangarh P, Shasthry SM, Patidar Y, Sarin SK. Salvage balloon occluded retrograde transvenous obliteration for gastric variceal bleed in cirrhotic patients with endoscopic failure to control bleed/very early rebleed: long-term outcomes. J Clin Exp Hepatol. 2020;10(5):421–8.

    Article  Google Scholar 

  11. Park JK, Saab S, Kee ST, Busuttil RW, Kim HJ, Durazo F, et al. Balloon-occluded retrograde transvenous obliteration (BRTO) for treatment of gastric varices: review and meta-analysis. Dig Dis Sci. 2015;60(6):1543–53.

    Article  Google Scholar 

  12. Saad WE, Lippert A, Saad NE, Caldwell S. Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol. 2013;16(2):158–75.

    Article  Google Scholar 

  13. Watanabe N, Toyonaga A, Kojima S, Takashimizu S, Oho K, Kokubu S, et al. Current status of ectopic varices in Japan: results of a survey by the Japan Society for Portal Hypertension. Hepatol Res. 2010;40(8):763–76.

    Article  Google Scholar 

  14. Haskal ZJ, Scott M, Rubin RA, Cope C. Intestinal varices: treatment with the transjugular intrahepatic portosystemic shunt. Radiology. 1994;191(1):183–7.

    Article  CAS  Google Scholar 

  15. Vangeli M, Patch D, Terreni N, Tibballs J, Watkinson A, Davies N, et al. Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol. 2004;41(4):560–6.

    Article  Google Scholar 

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Correspondence to Xuefeng Luo .

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Luo, X., Yang, L. (2022). Gastric Varices and Ectopic Varices. In: de Franchis, R. (eds) Portal Hypertension VII. Springer, Cham. https://doi.org/10.1007/978-3-031-08552-9_44

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  • DOI: https://doi.org/10.1007/978-3-031-08552-9_44

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-08551-2

  • Online ISBN: 978-3-031-08552-9

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