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Gastric variceal bleeding.
Curr Opin Gastroenterol. 2019 11; 35(6):524-534.CO

Abstract

PURPOSE OF REVIEW

There are no well-established guidelines for the management of gastric variceal bleeding. Endoscopic management of acute gastric variceal bleeding has been premised on the injection of sclerosants and synthetic glue. However, these therapies are associated with various complications including systemic embolization and recurrent bleeding. Recently, endoscopic ultrasound (EUS)-guided interventions including coil injection have emerged as promising modalities with high technical and clinical success rates and low rates of recurrence.

RECENT FINDINGS

In this review we discuss the classification, natural history, prognosis, and treatment options of gastric variceal. Discussion of treatment is further subdivided into primary and secondary prophylaxis and the management of acute gastric variceal bleeding with a focus on emerging endoscopic interventions.

SUMMARY

Cyanoacrylate injection may have a role in the primary and secondary prophylaxis of gastric variceal. Endoscopic band ligation should be considered for GOV1. EUS-guided injection of synthetic glues like cyanoacrylate is superior to direct injection. However, EUS-guided coil injections with or without cyanoacrylate should be considered first-line endoscopic treatment in all bleeding gastric variceal except for GOV1. Balloon retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunts (TIPS) remain important interventional radiologic therapeutic options as primary therapy in centers without EUS expertise or as salvage therapy.

Authors+Show Affiliations

Department of Medicine, Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31577562

Citation

Bazarbashi, Ahmad Najdat, and Marvin Ryou. "Gastric Variceal Bleeding." Current Opinion in Gastroenterology, vol. 35, no. 6, 2019, pp. 524-534.
Bazarbashi AN, Ryou M. Gastric variceal bleeding. Curr Opin Gastroenterol. 2019;35(6):524-534.
Bazarbashi, A. N., & Ryou, M. (2019). Gastric variceal bleeding. Current Opinion in Gastroenterology, 35(6), 524-534. https://doi.org/10.1097/MOG.0000000000000581
Bazarbashi AN, Ryou M. Gastric Variceal Bleeding. Curr Opin Gastroenterol. 2019;35(6):524-534. PubMed PMID: 31577562.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastric variceal bleeding. AU - Bazarbashi,Ahmad Najdat, AU - Ryou,Marvin, PY - 2019/10/3/pubmed PY - 2020/10/3/medline PY - 2019/10/3/entrez SP - 524 EP - 534 JF - Current opinion in gastroenterology JO - Curr Opin Gastroenterol VL - 35 IS - 6 N2 - PURPOSE OF REVIEW: There are no well-established guidelines for the management of gastric variceal bleeding. Endoscopic management of acute gastric variceal bleeding has been premised on the injection of sclerosants and synthetic glue. However, these therapies are associated with various complications including systemic embolization and recurrent bleeding. Recently, endoscopic ultrasound (EUS)-guided interventions including coil injection have emerged as promising modalities with high technical and clinical success rates and low rates of recurrence. RECENT FINDINGS: In this review we discuss the classification, natural history, prognosis, and treatment options of gastric variceal. Discussion of treatment is further subdivided into primary and secondary prophylaxis and the management of acute gastric variceal bleeding with a focus on emerging endoscopic interventions. SUMMARY: Cyanoacrylate injection may have a role in the primary and secondary prophylaxis of gastric variceal. Endoscopic band ligation should be considered for GOV1. EUS-guided injection of synthetic glues like cyanoacrylate is superior to direct injection. However, EUS-guided coil injections with or without cyanoacrylate should be considered first-line endoscopic treatment in all bleeding gastric variceal except for GOV1. Balloon retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunts (TIPS) remain important interventional radiologic therapeutic options as primary therapy in centers without EUS expertise or as salvage therapy. SN - 1531-7056 UR - https://www.unboundmedicine.com/medline/citation/31577562/Gastric_variceal_bleeding_ L2 - https://doi.org/10.1097/MOG.0000000000000581 DB - PRIME DP - Unbound Medicine ER -