Gastric Varix Disease
Gastric varices (GV) are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV.
Gastroesophageal varices have been seen in approximately 50% of patients with cirrhosis of the liver. Their presence correlates with the severity of liver disease. While only 40% of Child A patients has varices, they are present in 85% of Child C patients. Variceal hemorrhage occurs at a yearly rate of 5-15%, and 6-week mortality after variceal hemorrhage is about 20%. In general, variceal bleeding ceases spontaneously in 40-50% of patients, but incidence of early rebleeding ranges between 30% and 40% within first 6 weeks, and about 40% of all rebleeding episodes occur within the first 5 days.
Gastric varices (GV) bleed less frequently than esophageal varices and are responsible for 10-30% of all variceal hemorrhages. However, gastric variceal bleeding tends to be more severe with higher mortality. In addition, a high proportion of patients, around 35-90%, rebleed after spontaneous hemostasis.
New endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for GV. This review provides an overview of the classification and pathophysiology of GV, which have direct consequences for management; an introduction to current endoscopic and interventional radiological management options for GV.
The GVs are generally described and therapeutic decisions made based on their location and relationship with esophageal varices. Understanding the complex GV system is important in deciding on therapeutic options beyond endoscopic interventions. In general, via hepatofugal pathways, GV drain into the systemic circulation through two types of collateral systems. These are the gastroesophageal system, between the left gastric vein and the azygous vein and the gastrophrenic system between the gastric veins in the posterosuperior gastric wall; and left inferior phrenic vein at the gastrophrenic ligament near the bare area of the stomach. In isolated splenic vein thrombosis, the collateral circulation pathways form in hepatopetal manner .
Clinical Gastroenterology Journal accepts Original article, Mini review, Commentary, Short communication or Case report on the purview of gastroenterology field.
Manuscript can be submitted online .
Clinical Gastroenterology Journal