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World J Gastrointest Endosc. May 16, 2014; 6(5): 168-175
Published online May 16, 2014. doi: 10.4253/wjge.v6.i5.168
Update on gastric varices
Maria Triantafyllou, Adrian J Stanley
Maria Triantafyllou, Adrian J Stanley, Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, G4 OSF, United Kingdom
Author contributions: Stanley AJ designed the paper; Stanley AJ and Triantafyllou M wrote the manuscript and both approved the final copy.
Correspondence to: Dr. Adrian J Stanley, Department of Gastroenterology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4OSF, United Kingdom. adrian.stanley@ggc.scot.nhs.uk
Telephone: +44-141-2114073 Fax: +44-141-2115131
Received: November 8, 2013
Revised: April 3, 2014
Accepted: April 16, 2014
Published online: May 16, 2014
Core Tip

Core tip: Endoscopic injection of cyanoacrylate is currently the optimum, evidenced based approach to control active bleeding from gastric varices, apart from bleeding from gastro-oesophageal varice (GOV)-1 which can be treated with variceal band ligation. Transjugular intrahepatic portosystemic shunt (or balloon-occluded retrograde transvenous obliteration in experienced units) can be effective for ongoing bleeding. Cyanoacrylate or transjugular intrahepatic portosystemic shunt can prevent rebleeding from GOV-2 or isolated gastric varice, although variceal band ligation, cyanoacrylate or β-blockers can be used after bleeding from GOV-1. Non-selective β-blockers or cyanoacrylate may be used as primary prophylaxis in patients with known gastric varices, with the choice dependent on clinical and endoscopic findings.