Gastric varices are an important portosystemic collateral pathway, occurring in ~20% of patients with portal hypertension. They are considered distinct from esophageal varices in that they have a propensity to hemorrhage at comparatively lower portal pressures, and are also associated with higher mortality rate with hemorrhage. The patients with cirrhosis or high portal blood pressure are highly prone to gastric variceal bleeding than the patients with splenic vein thrombosis (SVT).

Complications

The bleeding leads to heavy loss of blood, which should be compensated by blood transfusion to regulate the blood circulation and to maintain the hemoglobin level 7-8 g/dL. This technique is a recovery approach to lower the risk of rebleeding and mortality. Gastric varices are treated by primary prophylaxis and secondary prophylaxis. The primary treatment includes drug therapy.

Cause

Gastric variceal bleeding may be caused by portal hypertension or splenic vein thrombosis. In the context of portal hypertension, emergency TIPS is often successful in controlling hemorrhage. Gastric variceal bleeding may be caused by portal hypertension or splenic vein thrombosis. In the context of portal hypertension, emergency TIPS is often successful in controlling Thrombosis may be candidates for splenectomy or splenic embolization as a means of definitive therapy; however, data are scarce. Splenectomy is often reserved for patients with isolated splenic vein thrombosis, and in the context of multiple splanchnic and portal thrombosis, treatment is more complicated. We report that splenectomy was a successful treatment for this patient with gastric varices and multivessel extrahepatic thromboses secondary to essential thrombocythemia.

Complications

The bleeding leads to heavy loss of blood, which should be compensated by blood transfusion to regulate the blood circulation and to maintain the hemoglobin level 7-8 g/dL. This technique is a recovery approach to lower the risk of rebleeding and mortality. Gastric varices are treated by primary prophylaxis and secondary prophylaxis. The primary treatment includes drug therapy.

Treatment

Endoscopic treatments have been used to prevent rebleeding. Sclerotherapy has been abandoned because of high rebleeding rates (50%–90%). Variceal band ligation may be used for those patients with GOV1 and in some cases of small GOV2, and it is generally performed every 2 weeks until apparent endoscopic obliteration.  Endoscopic ultrasound guided treatment is a new modality for treatment of GV and this has emerged as a valuable tool for diagnosis, treatment planning, evaluation of treatment efficacy, estimation of recurrent bleeding potential and also helps visualize varices, perforating veins, collateral veins and allows predict varices at high risk.

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Regards
Jessica Watson
Managing Editor
Clinical Gastroenterology Journal