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Updated: May 24, 2026
04:09
Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
Treatment modalities for bleeding esophagogastric varices
Hiroshi Yoshida1, Yasuhiro Mamada, Nobuhiko Taniai
1Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
Summary
This review covers the management of bleeding esophageal varices (EVs) and gastric varices (GVs), common in chronic liver disease. Endoscopic treatments are increasingly favored, alongside pharmacologic and interventional radiology options, to control hemorrhage and prevent recurrence.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Radiology
Background:
- Bleeding from esophageal varices (EVs) and gastric varices (GVs) is a severe complication of chronic liver disease.
- Varices are graded based on location, with cardiac varices (CVs) and fundal varices (FVs) being key distinctions for management.
Purpose of the Study:
- To review the current management strategies for bleeding EVs and GVs.
- To discuss diagnostic classifications and various treatment modalities.
Main Methods:
- Review of existing literature on the diagnosis and management of variceal bleeding.
- Discussion of endoscopic treatments (ligation, sclerotherapy), pharmacologic therapy, surgery, and interventional radiology techniques.
- Classification of GVs into cardiac and fundal varices for targeted management.
Main Results:
- Endoscopic treatment, particularly endoscopic variceal ligation for EVs and tissue adhesive injection for GVs, is a primary approach.
- Pharmacologic therapy and interventional radiology (e.g., transportal obliteration) serve as crucial alternatives or adjuncts.
- Sengstaken-Blakemore tube placement is a temporary measure for uncontrolled bleeding.
Conclusions:
- Effective management of bleeding EVs and GVs involves a combination of endoscopic, pharmacologic, and interventional radiology techniques.
- Preventing recurrent variceal hemorrhage requires complete eradication of varices and maintaining low portal venous pressure.
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