Update on the management of gastrointestinal varices

Figure 1 Mechanism of portal hypertension and the development of gastrointestinal varices. VEGF: Vascular endothelial growth factor; PDGF: Platelet-derived growth factor; NO: Nitric oxide; HVPG: Hepatic venous pressure gradient.

Figure 2 Mechanism of variceal bleeding. P: Pressure; R: Radius; WT: Wall thickness.

Figure 3 Screening endoscopy for esophageal varices per practice society guidelines[38,48]. NSBBs: Nonselective beta-blockers; EVL: Endoscopic variceal ligation; EGD: Esophago-gastro duodenoscopy; LS: Liver stiffness; PLT: Platelet.

Figure 4 Endoscopic variceal ligation for primary prophylaxis. A: Esophageal varices before banding; B: Esophageal varix post banding.

Figure 5 Bleeding esophageal varices.

Figure 6 High-risk stigmata of bleeding from esophageal varices. A: Platelet-fibrin plug on esophageal varix (white nipple sign); B: Bleeding esophageal varix post banding.

Figure 7 Endoscopic variceal band ligation.

Figure 8 Metal stents for the treatment of bleeding esophageal varices. A: Bleeding esophageal varix before stenting; B: Esophageal varix after metal stent.

Figure 9 Sarin classification of gastric varices. GOV1: Gastroesophageal varix type 1; GOV2: Gastroesophageal varix type 2; IGV1: Isolated gastric varix type 1; IGV2: Isolated gastric varix type 2.

Figure 10 Gastric varices.

Figure 11 Algorithm for the management of acute variceal bleed. ICU: Intensive care unit; EGD: Esophago-gastro duodenoscopy; NSBB: Nonselective beta blockers; EVL: Endoscopic variceal ligation; TIPS: Transjugular intrahepatic portosystemic shunt.