Management of Gastric Varices: GI Perspective

Abstract There is a paucity of literature on the management of gastric varices and current guidelines rely heavily on expert opinion. Optimal treatment of gastric varices requires a multidisciplinary team including gastrointestinal endoscopist, hepatologist, and interventional radiologists. Initial management relies on endoscopic diagnosis followed by therapeutic modalities based on the experience of the endoscopist and the institution. Definitive management may be endoscopic, endovascular, or a combination of the two disciplines. In this review, we discuss endoscopic management of gastric varices with direct endoscopic glue injection, endoscopic ultrasound-guided management, limitations, and adverse events. We conclude by describing a case of gastric variceal bleeding managed with endoscopy when interventional radiographic techniques were not feasible.