Update on the management of gastric varices

Luo, Xuefeng; Hernández‐Gea, Virginia

doi:10.1111/liv.15181

Cited by 15 publications

(11 citation statements)

References 82 publications

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“…In our study, 70.0% of the patients had IGV1, a finding that aligns with another study conducted in Pakistan [ 21 ]. However, this percentage contrasts with that described in international studies [ 7 ]. In our study, 100% of patients achieved hemostasis with n-butyl-2-cyanoacrylate therapy for fundal varices bleeding.…”

Section: Discussioncontrasting

confidence: 91%

“…Gastric varices (GVs) are less common and present in approximately 20% of patients with liver cirrhosis [ 3 - 6 ]. GVs are classified according to the Sarin classification, which is based on their anatomical location in the stomach and their communication, or lack thereof, with esophageal varices [ 7 ]. Gastro-esophageal varices type 1 (GOV1) refer to esophageal varices that extend towards the cardia or the lesser curvature of the stomach.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Therapy of Gastric Varices: Safety and Efficacy of N-Butyl-2-Cyanoacrylate Injection

Iqbal Janjua,

Ahmad,

Javed

et al. 2023

Cureus

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Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in significant morbidity, mortality, and socioeconomic burden. Both types of cardio-fundal varices, gastro-esophageal varix 2 (GOV2) and isolated gastric varices type 1 (IGV1), can cause massive bleeding and often are difficult to treat compared to the other types of gastric varices. Endoscopic variceal band ligation (EVBL) is a less effective treatment modality for gastric varices than esophageal varices and is associated with high re-bleeding rates. N-butyl-2-cyanoacrylate (Histoacryl) injection is an effective and potential treatment option for fundal varices. This study aims to evaluate the safety and efficacy of n-butyl-2-cyanoacrylate injection therapy in cardio-fundal varices. Objective To assess the efficacy and safety of n-butyl-2-cyanoacrylate injection therapy for fundal varices. Methods This retrospective observational cohort study was conducted at the Department of Gastroenterology, Allied Teaching Hospital, Gujranwala, over one year. All patients, irrespective of age and gender, presenting with UGIB and in whom fundal varices were diagnosed on gastroscopy followed by n-butyl 2-cyanoacrylate injection therapy were included in this study. The efficacy and safety of Histoacryl therapy were assessed by analyzing successful hemostasis, frequency of re-bleeding, obliteration, and regression of fundal varices on repeat endoscopy. Adverse events such as re-bleeding and mortality related to fundal variceal treatment were documented. Results A total of 60 patients were included in the study. Of these, 70% had IGV1, while the remaining 30% had GOV2. Hemostasis was achieved in 100% of patients following n-butyl-2-cyanoacrylate injection. Successful obliteration with regression of varices was observed in 91.3% of patients. Various adverse events were observed, with abdominal pain being the most common observed complication in 18.3% of participants. However, only 8.3% of participants developed re-bleeding due to ulcer formation at the injection site, and no death occurred directly due to fundal variceal treatment. Conclusion N-butyl-2-cyanoacrylate injection therapy is a lifesaving, effective, and safe intervention for controlling bleeding from cardio-fundal varices, leading to improved health status and a consequent decrease in episodes of recurrent bleeding. Its side effects are few and infrequent. However, larger-scale studies are needed to further evaluate the safety and effectiveness of n-butyl-2-cyanoacrylate injection therapy. These studies will be crucial in establishing comprehensive guidelines for the management of fundal varices.

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Section: Discussioncontrasting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Endoscopic Therapy of Gastric Varices: Safety and Efficacy of N-Butyl-2-Cyanoacrylate Injection

Iqbal Janjua,

Ahmad,

Javed

et al. 2023

Cureus

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“…30 Although, it is unclear if increased portal vein cross-sectional area also represents portal hypertension, which in the long term might increase the potential for gastrointestinal thrombosis or hemorrhage. 31 How blood flows through these distended vessels also appears to become altered. Visualization using ultrasound found blood flow stagnation, increased turbulence, and even reversal of flow in astronauts’ internal jugular veins while in low Earth orbit.…”

Section: Blood Flow During Space Travelmentioning

confidence: 99%

Managing Hemostasis in Space

White,

Wenthe

2023

ATVB

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Human space travel requires exposure to weightlessness, ionizing radiation, isolation, and austerity. A recent report of internal jugular vein thrombosis in astronauts in low Earth orbit confirms that these exposures also affect vascular biology to influence diseases of thrombosis and hemostasis. This brief review summarizes the known influences of space travel on inflammation, blood coagulation, and the cardiovascular system and conceptualizes how they might combine to affect thrombosis and hemostasis. In the event of a major thrombotic or bleeding emergency, it is anticipated that the unique physiological influences of the space environment and logistical limitations of providing medical care in space would require a response that is unique from our current experience. We also look towards the future to discuss lessons learned from our current experiences on Earth and in space.

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“…Generally, therapeutic strategies for cirrhosis-derived gastric varices contain endoscopic interventions, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunt, etc. 8 , 9 However, gastric varices derived from liver cirrhosis or LSPH have different vascular anatomy, which results in the difference in the management of GI bleeding. Therapeutic strategies for bleeding from LSPH include endoscopic interventions, partial splenic arterial embolization (PSAE), and splenectomy.…”

Section: Introductionmentioning

confidence: 99%

Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis

Liu,

Wei,

Song

2024

Therap Adv Gastroenterol

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Objectives: Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies. Design: A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH. Data sources and methods: All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark). Results: Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06–0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01–0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01–0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20–1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy. Conclusion: This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients. Trial registration: This study has been registered on the PROSPERO database with the registration number CRD42023483764.

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Update on the management of gastric varices

Cited by 15 publications

References 82 publications

Endoscopic Therapy of Gastric Varices: Safety and Efficacy of N-Butyl-2-Cyanoacrylate Injection

Endoscopic Therapy of Gastric Varices: Safety and Efficacy of N-Butyl-2-Cyanoacrylate Injection

Managing Hemostasis in Space

Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis

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