Bleeding isolated gastric varices: a retrospective analysis.

Area of Science:

• Gastroenterology
• Hepatology
• Vascular Surgery

Background:

• Isolated gastric varices (IGV) are uncommon and typically linked to left-sided portal hypertension.
• Understanding the underlying causes and optimal treatment for IGV is crucial for patient outcomes.

Purpose of the Study:

• To investigate the etiological factors and portovenographic findings in patients with bleeding IGV.
• To compare these findings with patients experiencing bleeding from both esophageal and gastric varices.
• To evaluate the efficacy of surgical interventions for controlling IGV bleeding.

Main Methods:

• Retrospective analysis of 14 patients with bleeding IGV.
• Comparison of portovenography findings (collateralization patterns, natural shunts) with a matched cohort of 69 patients with esophageal and gastric varices.
• Assessment of surgical outcomes, specifically abdominal devascularization.

Main Results:

• 12 out of 14 IGV patients had generalized portal hypertension; only 2 had isolated splenic vein thrombosis.
• Left-sided collateralization was significantly more prevalent in IGV patients (8/11) compared to those with esophageal and gastric varices (17/69, p=0.004).
• Abdominal devascularization demonstrated effective short- and long-term bleeding control.

Conclusions:

• Contrary to common belief, generalized portal hypertension is a more frequent cause of IGV than splenic vein obstruction.
• The pattern of collateralization, particularly left-sided pathways, may predispose to IGV.
• Treatment strategies for IGV should be more extensive than simple splenectomy, considering the underlying generalized portal hypertension.