Gastric varices

Abstract

Purpose of review Gastric varices are a rare cause of gastrointestinal bleeding in patients with portal hypertension. There have been significantly advances within endoscopic ultrasound for treatment of gastric varices over the past 5 years in addition to the conventional endoscopic and endovascular therapies. In this review, we will review the latest literature on gastric varices with emphasis on changes to the conventional classification systems and comparisons among the different treatment options for gastric varices in terms of efficacy and safety. Recent findings There have been new guidelines proposed by the American Gastrointestinal Association on a simpler classification system compared to the conventional Sarin classification. In addition, endoscopic ultrasound guided coil embolization, a novel treatment pioneered over the past 5 years for gastric varices, has shown increased efficacy and reduced adverse event profile compared to cyanoacrylate glue, the more traditional therapy for gastric variceal bleeding. Options for endovascular therapy overall have not significantly changed over the recent years. Summary Based on our literature review, we recommend a step-up approach with initial medical and endoscopic management with consideration of endovascular therapies when initial therapies fail.

Prospective Visual Inspection of the Ventrum of Tongue (VIVOT) Vasculature Predicts the Presence of Esophageal Varices

“…Website for Sarin classification: grades of gastric varices-Search (bing.com accessed on 7 November 2023). We used a simplification of this method originally for ease of operation, but it has since been superseded by newer classifications [9].…”

“…We postulate that shunting of venous blood from the splanchnic to the systemic venous system through collateral venous connections increases pressure in the lingual venous bed of vessels, as previously suggested by others [1] and may co-occur with the appearance of EVs. Therefore, theoretically, a visual inspection of the ventrum of the tongue (VIVOT) could predict the presence of EV and gastric varices [9]. The aims and objectives of this study were to test the performance of VIVOT for predicting EVs via endoscopy.…”