Secondary gastric varices in hepatic cirrhosis

To determine the frequency of secondary gastric varices after esophageal variceal eradication in patients with cirrhosis of liver and factors associated with their development.

Observational study.

The Department of Gastroenterology, Liaquat University Hospital, Jamshoro and Isra University Hospital Hyderabad, from September 2007 to July 2009.

Consecutive patients with decompensated cirrhosis of liver were subjected to endoscopy for management of varices. Endoscopic variceal band ligation was done in all patients. Secondary gastric varices were noted at surveillance. Receiver-operating characteristic (ROC) curves were used to determine the cut off values of secondary gastric varices and various factors influencing the development of gastric varices after eradication with the best sensitivity and specificity.

Of the 162 patients; 46 (28.3%) were females and 116 (71.7%) males. The mean age was 45 ±13 years. Fundal varices were present before eradication in 12 (7.4%) patients and after eradication of varices in 38 (23.5%) patients. A strong association was found between gastric varices after eradication and Child Pugh class (p=0.001), grade of varices at the time of presentation (p=0.024), increasing number of sessions for eradication of esophageal varices (p=0.001) and presence of gastric varix at the time of first presentation (p=0.009).

Secondary gastric varices are common in cirrhosis. A significant association with Child-Pugh class, presenting grade, increasing number of ligation session and prior existence was seen in the studied group.