S K Sarin1. 1. Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
Abstract
BACKGROUND: Bleeding from gastric varices is often a serious medical emergency. The role of endoscopy in the management of gastric variceal bleeding is still controversial. The types of gastric varices and their respective management strategies have not been identified. METHODS: Gastric varices were observed in 209 patients with portal hypertension. Seventy-one patients (with cirrhosis 33, noncirrhotic 38) underwent gastric variceal sclerotherapy, 53 of these (75%) for gastric variceal bleeding. By use of a previously described classification, gastric varices were divided into gastroesophageal varices, type 1 (GOV1) and type 2 (GOV2), and isolated gastric varices, type 1 (IGV 1). Gastric variceal sclerotherapy was done every week using a combination technique of paravariceal and intravariceal injections with absolute alcohol. RESULTS: Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 +/- 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure. CONCLUSIONS: (1) Sclerotherapy can effectively arrest acute gastric variceal bleeding and achieve gastric variceal obliteration, (2) it is more effective in patients with gastroesophageal varices, and (3) alternative therapies need to be evaluated for patients with IGV1.
BACKGROUND:Bleeding from gastric varices is often a serious medical emergency. The role of endoscopy in the management of gastric variceal bleeding is still controversial. The types of gastric varices and their respective management strategies have not been identified. METHODS: Gastric varices were observed in 209 patients with portal hypertension. Seventy-one patients (with cirrhosis 33, noncirrhotic 38) underwent gastric variceal sclerotherapy, 53 of these (75%) for gastric variceal bleeding. By use of a previously described classification, gastric varices were divided into gastroesophageal varices, type 1 (GOV1) and type 2 (GOV2), and isolated gastric varices, type 1 (IGV 1). Gastric variceal sclerotherapy was done every week using a combination technique of paravariceal and intravariceal injections with absolute alcohol. RESULTS: Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 +/- 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure. CONCLUSIONS: (1) Sclerotherapy can effectively arrest acute gastric variceal bleeding and achieve gastric variceal obliteration, (2) it is more effective in patients with gastroesophageal varices, and (3) alternative therapies need to be evaluated for patients with IGV1.
Authors: Won Seok Jang; Hyun Phil Shin; Joung Il Lee; Kwang Ro Joo; Jae Myung Cha; Jung Won Jeon; Jun Uk Lim Journal: World J Gastroenterol Date: 2014-12-07 Impact factor: 5.742