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Updated: Oct 4, 2025
Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
Update on the management of gastric varices
Xuefeng Luo1, Virginia Hernández-Gea2
1Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China.
Insights
Gastric varices (GV) bleeding, a complication of cirrhosis, is severe and life-threatening. This review details GV management options, highlighting the need for multidisciplinary evaluation due to treatment controversies.
Area of Science:
- Hepatology
- Gastroenterology
- Interventional Radiology
Background:
- Gastro-oesophageal varices are key indicators of cirrhosis and portal hypertension.
- Gastric varices (GV) bleeding, though less common than oesophageal varices (EV), presents higher mortality and rebleeding risks.
- Sarin's classification categorizes GVs based on location and relationship with EV.
Purpose of the Study:
- To review the hemodynamic features of gastric varices.
- To explore current pharmacological, endoscopic, and interventional radiological treatment options for GV.
- To address the controversies and complexities in GV management strategies.
Main Methods:
- Literature review of hemodynamic features, classification, and treatment modalities for gastric varices.
- Analysis of current therapeutic options including beta-blockers, endoscopic interventions, and radiological procedures.
- Discussion on the challenges and need for multidisciplinary approaches in GV management.
Main Results:
- Gastric varices present unique hemodynamic challenges.
- A range of treatments exist, including endoscopic cyanoacrylate injection and transjugular intrahepatic portosystemic shunts.
- Optimal treatment strategy remains debated due to data limitations and study designs.
Conclusions:
- Effective management of gastric varices requires a comprehensive understanding of their hemodynamics.
- A multidisciplinary team approach integrating endoscopic and radiological expertise is crucial for optimal patient outcomes.
- Further high-quality research is needed to establish definitive treatment algorithms for gastric varices.
Abstract:
Gastro-oesophageal varices are the major clinical manifestations of cirrhosis and portal hypertension. Although less frequent than oesophageal varices (EV), bleeding from gastric varices (GV) is generally more severe and associated with higher mortality and a greater risk to rebleed. According to Sarin's classification, GVs are categorized into four types based on their location within the stomach and relationship with EV. Currently, treatment options for the management of GV include beta-blockers, endoscopic band ligation, endoscopic cyanoacrylate injection, EUS-guided coil/cyanoacrylate injection, transjugular intrahepatic portosystemic shunts and balloon-occluded retrograde transvenous obliteration. The best treatment strategy of GV remains controversial because of the heterogeneity of GV, lack of high-quality data and suboptimal trial design of the studies available. The proper treatment algorithm may require adequate endoscopic and imaging evaluation by a multidisciplinary team with multiple treatment options available. This review describes the hemodynamic features of GV, pharmacological, endoscopic and interventional radiological treatment options for GV.
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