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gastric varices
See esophageal varices
Etiology:
- cirrhosis
Epidemiology:
- 20% of patients with cirrhosis
Radiology:
- contrast enhanced abdominal CT to delineate anatomy of abdominal vasculature
- identifies splenic vein thrombosis, portal vein thrombosis & collateral circulation around thrombosed vein (abdominal ultrasound would not)
Management:
- octreotide to reduce portal hypertension
- broad spectum antibiotics to reduce infectious complications
- treatment of gastric varices along the greater curvature of the stomach depends upon anatomy of the abdominal vasculature
- for isolated gastric varices due to splenic vein thrombosis, splenectomy can reduce the gastric varices
- if the portal vein is patent & a suitable splenorenal shunt is available, retrograde transvenous balloon obliteration of varices may be considered
- if anatomy of hepatic vein & portal vein is favorable, TIPS may be an option
- gastric fundus varices are more frequent with portal vein thrombosis or splenic vein thrombosis
- endovascular obliteration is an option in patients with adequate collateral circulation
- gastric varices in the gastric fundus are not amenable to band ligation
- gastric varices in the gastric cardia (esophagus into lesser curvature) are amenable to band ligation
Related
esophageal varices
General
varicose vein (varix)
gastric disease
portosystemic shunt
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 19.
American College of Physicians, Philadelphia 1998, 2019
- Koch D
Update in the management of gastric varices.
Curr Opin Gastroenterol 2016:32:166-71
PMID: 27054775