Overview
Bleeding gastric varices represent a severe complication often associated with portal hypertension, leading to significant morbidity and mortality due to acute hemorrhage.Diagnosis
Clinical Presentation: Acute upper gastrointestinal bleeding 4.
Endoscopic Evaluation: Visualization of varices via upper endoscopy 4.
Imaging Techniques:
- Percutaneous Splenoportography: Useful for identifying actively bleeding varices 4.
- Endoscopic Ultrasound (EUS): Can delineate submucosal lesions and confirm varix anatomy 2.
- Angiography: Demonstrates vascular anatomy and active bleeding sites 34.Management
First-Line Treatments:
- Endoscopic Therapy: Band ligation, sclerotherapy 4.
- Transcatheter Arterial Embolization (TAE): For persistent bleeding 3.
Adjunctive Treatments:
- Cyanoacrylate Glue Injection: Effective for obliteration of varix 2.
- Percutaneous Transhepatic Embolization: Used in complex cases like stomal varices 3.Special Populations
Elderly Patients:
- Mortality and major complications in patients ≥80 years with gastric bleeding are comparable to younger elderly patients 1.
- Invasive treatments do not show differential prognosis in this age group 1.Key Recommendations
Utilize Endoscopic Techniques for Initial Management: Employ endoscopic band ligation or sclerotherapy for bleeding gastric varices (Evidence: Moderate 4).
Consider Transcatheter Arterial Embolization for Refractory Bleeding: Use TAE when endoscopic interventions fail (Evidence: Moderate 3).
Evaluate Older Adults Without Discounting Invasive Treatments: Invasive procedures can be safely considered in patients aged ≥80 years without expecting worse outcomes (Evidence: Moderate 1).References
1 Rosa F, Covino M, Fransvea P, Cozza V, Quero G, Fiorillo C et al.. Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study. BMJ open 2022. link
2 Rana SS, Bhasin DK, Rao C, Singh K. Endoscopic ultrasound-guided treatment of bleeding duodenal varix. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2011. link
3 Toumeh KK, Girardot JD, Choo IW, Andrews JC, Cho KJ. Percutaneous transhepatic embolization as treatment for bleeding ileostomy varices. Cardiovascular and interventional radiology 1995. link
4 Hourigan KJ. Radiographic demonstration of gastric variceal bleeding. Gut 1971. link