Significance of isolated gastric varices among Chinese patients

Isolated gastric varices rarely occurs, and was considered as a hint of pancreatic disease rather than liver cirrhosis. Recently, the frequency of acute gastrointestinal bleeding secondary to isolated gastric varices tended to increase among cirrhotic patients. We therefore conducted this retrospective study to analyze its possible etiologies.

Thirty-six cases of isolated gastric varices were found in an extensive review of the endoscopic records at our hospital from 1984 to 1993. Gastric varices developed after injection sclerotherapy of esophageal varices were excluded. Medical records were reviewed to determine their etiologies.

The underlying disorders of these 36 patients included liver cirrhosis in 26 patients (72.2%), pancreatic diseases in 7 patients (19.4%), myelofibrosis in 1 patient (2.7%), and unknown cause in 2 patients (5.5%). Among those with liver cirrhosis, portal hemodynamic study conducted in 5 patients to find all with a high level of portal venous pressure; angiography conducted in 5 patients also found all with gastric varices. Among those with pancreatic diseases, angiography and/or splenoportography was conducted in 5 patients to evidence all with gastric varices, splenic vein obstruction and splenomegaly.

Isolated gastric varices identified in endoscopy can first strongly suggests the presence of liver cirrhosis with portal hypertension. Pancreatic diseases complicating with splenic vein obstruction is the second possible underlying etiology.