Endoscopic therapy for bleeding gastric varices: to clot or glue?

摘要

Major advances in the management of bleeding esophageal varices over the last two decades have resulted in significant reduction in disease mortality. Most gastroen-terologists are comfortable treating such patients, and there have been recent detailed guidelines on their management published by the American Association for the Study of Liver Diseases (AASLD). However, the optimal therapy for bleeding gastric varices (GVs) remains a controversial topic. Sarin et al defined 4 subtypes of GVs: Gastroesophageal varices (GOVs) are associated with esophageal varices along the lesser curve (type 1 [GOV1]), or along the fundus (type 2 [G0V2]); isolated gastric varices (IGVs) are present in isolation in the fundus (IGV1) or at ectopic sites in the stomach or the first part of the duodenum (IGV2). GOVls are responsible for 7096 of GVs, and can be managed as esophageal varices. It is for the other types that the clinician is faced with a number of choices.