Bleeding Gastric Varices: Frequency and Outcome

Abstract

Background and aims: Gastric variceal (GV) bleeding is less frequent than esophageal variceal (EV) bleeding but it is still a serious cause of morbidity and mortality.The aim of study was to assess the frequency and identify the patients' outcome after management. Patients and methods: The study was conducted on 500 cirrhotic patients with upper gastrointestinal bleeding the period from June 2016 to June 2017.All patients were subjected to complete history taking, clinical examination, laboratory investigations, abdominal US and esophago-gastro-duodenoscopy (EGD) for detection of the source of bleeding. If bleeding GVs were detected, Cyanoacrylate was injected into them to achieve primary haemostasis. Results: Endoscopic examination revealed bleeding GV in 50 patients (10 %), bleeding EV in 400 patients (80%), while bleeding from other sources was in 50 patients (10%).In the GV group, thirty-five patients (70%) had isolated GV (type I) and 15 patients (30%) had continuous Gastroesophogeal varices (type 2).Most patients (80%) with GV had red colour signs (Rc+).PHG was seen in 48 patients (96%). After Cyanoacrylate injection of GV, 40% developed eradication, 38% died & 22% developed re-bleeding.Upon studying the predictors of mortality, we found that patients who died had significantly lower albumin & higher ALT & AST levels. Early re-bleeding was more common among Child A patients with moderately sized GV (F2), but the difference was not statisticallysignificant. By multivariate analysis we found no independent predictors of mortality or re-bleeding. Conclusions: Bleeding GVs represents 10% of upper GIT bleeding in cirrhotic patients. No independent factors could predict the mortality or re-bleeding among cirrhotic patients with bleeding GVs by multivariate analysis.