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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
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Gastritis is marked by disruption of the mucosal barrier that usually protects the stomach tissue from digestive juices and manifests in acute and chronic forms.
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Gastric variceal bleeding.

Ahmad Najdat Bazarbashi1, Marvin Ryou

  • 1Department of Medicine, Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA.

Current Opinion in Gastroenterology
|October 3, 2019
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Summary
This summary is machine-generated.

Endoscopic ultrasound (EUS)-guided coil injection is a promising first-line treatment for gastric variceal bleeding, offering high success and low recurrence rates compared to traditional methods.

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Area of Science:

  • Gastroenterology
  • Endoscopic interventions
  • Hepatology

Background:

  • Gastric variceal bleeding lacks established management guidelines.
  • Traditional endoscopic therapies (sclerosants, glue injection) have complications like embolization and rebleeding.
  • Endoscopic ultrasound (EUS)-guided interventions are emerging as effective alternatives.

Purpose of the Study:

  • To review the classification, natural history, prognosis, and treatment of gastric varices.
  • To focus on emerging endoscopic interventions for acute gastric variceal bleeding.
  • To compare different endoscopic and interventional radiology techniques.

Main Methods:

  • Review of current literature on gastric varices management.
  • Discussion of endoscopic techniques including cyanoacrylate injection, band ligation, EUS-guided interventions (coil, glue).
  • Evaluation of interventional radiology options like BRTO and TIPS.

Main Results:

  • EUS-guided coil injection with or without cyanoacrylate is recommended as first-line treatment for most gastric variceal bleeding, except GOV1.
  • Cyanoacrylate injection may aid in prophylaxis.
  • Endoscopic band ligation is suitable for GOV1.
  • BRTO and TIPS are important alternatives, especially in centers lacking EUS expertise or as salvage therapy.

Conclusions:

  • EUS-guided coil injection represents a significant advancement in managing gastric variceal bleeding.
  • Treatment selection should consider variceal type and available expertise.
  • Further research may refine guidelines for these complex cases.