Endoscopic Obliteration of Gastric Varices

Abstract

Gastric varices are present in 5–33% of patients with portal hypertension and have a reported bleeding incidence of approximately 25% in 2 years. Gastric varices are more common in patients with noncirrhotic portal hypertension and extrahepatic portal vein obstruction. The risk of bleeding from gastric varices is lower than that of esophageal variceal bleeding but is generally more severe, and the associated mortality is significantly higher.The management of gastric varices remains a therapeutic challenge. Because there are few controlled clinical trials, the strength of the evidence underlying guidelines for management of gastric varices is weaker compared to their esophageal counterparts.Traditional endoscopic sclerotherapy is ineffective because gastric varices are usually associated with a gastrorenal shunt or a gastrocaval shunt resulting in outflow into the systemic circulation and high flow rate with a resultant rapid escape of sclerosant into the systemic circulation, delayed onset of local thrombosis, and a higher risk of distal serious complications.Obturation or obliteration is the term used for gastric varices treated with glue rather than eradication, as the varix itself can remain visible even when effectively treated, as will be demonstrated in the video. This article is part of an expert video encyclopedia.