Gastroenterology
Volume 126, Issue 4 , Pages 1175-1189 , April 2004

A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices

  • Barbara M. Ryan

      Affiliations

    • Department of Gastroenterology, Manchester Royal Infirmary, Manchester, United Kingdom UK
    • Corresponding Author InformationAddress requests for reprints to: Barbara Ryan, M.D., MSc, MRCPI, Department of Gastroenterology, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, England UK fax: (44) 161 2768779
    • ,
  • Reinhold W. Stockbrugger

      Affiliations

    • Department of Gastroenterology, University Hospital Maastricht, Maastricht, The Netherlands
    • ,
  • J.Mark Ryan

      Affiliations

    • Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North CarolinaUSA

Received 12 February 2003 ,Accepted 7 October 2003.

References 

  1. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices (a long-term follow-up study in 568 portal hypertension patients). Hepatology. 1992;16:1343–1349
  2. Smith JL, Graham DY. Variceal hemorrhage. A critical evaluation of survival analysis. Gastroenterology. 1982;82:962–973
  3. D’Amico G, de Franchis R. End-of-the-century reappraisal of the 6-week outcome of upper gastrointestinal bleeding in cirrhosis. A prospective study. (abstr) Gastroenterology. 1999;117:A1199
  4. Rockey DC. Management of gastric varices. Gastroenterology. 2001;120:1875–1877
  5. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc. 1986;32:264–268
  6. Thakeb F, Salem SA, Abdallah M, el Batanouny M. Endoscopic diagnosis of gastric varices. Endoscopy. 1994;26:287–291
  7. Bretagne JF, Dudicourt JC, Morisot D, Thevenet F, Raoul JL, Gastard J. Is endoscopic variceal sclerotherapy effective for the treatment of gastric varices. (abstr) Dig Dis Sci. 1986;31:505S
  8. Sarin SK. Long-term follow-up of gastric variceal sclerotherapy (an eleven-year experience). Gastrointest Endosc. 1997;46:8–14
  9. Stadelmann E. Ueber seltene formenvon blutungen im tractus gastrointestinalis. Berl Klin Wochenscher. 1913;60:825–829
  10. Evans JA, Delany F. Gastric varices. Radiology. 1953;60:46–50
  11. Feldman M, Feldman M. Gastric varices. Gastroenterology. 1956;30:318–321
  12. Karr S, Wohl GT. Clinical importance of gastric varices. N Engl J Med. 1960;263:665–669
  13. Sarin SK, Kumar A. Gastric varices (profile, classification, and management). Am J Gastroenterol. 1989;84:1244–1249
  14. Sarin SK, Primignani M, Agarwal SR. Gastric varices. In:  de Franchis R editors. Portal hypertension. London: Blackwell Science; 2001;p. 76–96 Proceedings of the third Baveno international consensus workshop on definitions, methodology and therapeutic strategies
  15. Hosking SW, Johnson AG. Gastric varices (a proposed classification leading to management). Br J Surg. 1988;75:195–196
  16. Hashizume M, Kitano S, Yamaga H, Koyanagi N, Sugimachi K. Endoscopic classification of gastric varices. Gastrointest Endosc. 1990;36:276–280
  17. Yasumoto M. Clinical observations on 100 cases of gastric varices. Jpn J Gastroenterol. 1971;68:721–739
  18. Idezuki Y, Hypertension JRSP. General rules for recording endoscopic findings of esophago-gastric varices. World J Surg. 1991;19:420–423
  19. Rosch W. Isolated gastric varices (a hint to pancreatic disorders). Endoscopy. 1974;6:217–220
  20. Madsen MS, Petersen TH, Sommer H. Segmental portal hypertension. Ann Surg. 1986;204:72–77
  21. Sutton JP, Yarborough DY, Richards JT. Isolated splenic vein occlusion. Arch Surg. 1970;100:623–626
  22. Evan GR, Yellin AE, Weaver FA, Stain SC. Sinistral (left-sided) portal hypertension. Am Surg. 1990;56:758–763
  23. Spence RAJ. The venous anatomy of the lower oesophagus in normal subjects and in patients with varices (an image analysis study). Br J Surg. 1984;71:739–744
  24. Mohletaler C, Gerlock AJ, Goncharenko V, Avant GR, Flexner JM. Gastric varices secondary to splenic vein occlusion (radiographic diagnosis and clinical significance). Radiology. 1979;132:593–598
  25. Okuda K, Yasumoto M, Goto A, Kunisaki T. Endoscopic observations of gastric varices. Am J Gastroenterol. 1973;60:357–365
  26. Lo GH, Lai KH, Cheng JS, Huang RL, Wang SJ, Chiang HT. Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc. 1999;49:428–436
  27. Okuda K, Suzuki K, Musha H, Arimizu N. Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts (a preliminary report). Gastroenterology. 1977;73:279–284
  28. Lunderquist A, Vang J. Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med. 1974;291:646–649
  29. Vianna A, Hayes PC, Moscoso G, Driver MO, Portmann B, Westaby D, et al. Normal venous circulation of the gastroesophageal junction (a route to understanding varices). Gastroenterology. 1987;93:876–889
  30. Anderson CA. GI magnetic resonance angiography. Gastrointest Endosc. 2002;55:S42–S48
  31. Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K. Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology. 1988;95:434–440
  32. Hashizume M, Kitano S, Sugimachi K, Sueishi K. Three-dimensional view of the vascular structure of the lower oesophagus in clinical portal hypertension. Hepatology. 1988;8:1482–1487
  33. Arakawa M, Masuzaki T, Okuda K. Pathomorphology of esophageal and gastric varices. Semin Liver Dis. 2002;22:73–82
  34. Matsumoto A, Hamamoto N, Nomura T, Hongou Y, Arisaka Y, Morikawa H, et al. Balloon-occluded retrograde transvenous obliteration of high-risk gastric fundal varices. Am J Gastroenterol. 1999;94:643–649
  35. Sarin SK, Lahoti D. Management of gastric varices. Baillieres Clin Gastroenterol. 1992;6:527–548
  36. Little AG, Moosa AR. Gastrointestinal hemorrhage from left sided portal hypertension (an unappraised complication of pancreatitis). Am J Surg. 1981;141:153–158
  37. Suhocki PV, Berend KR, Trotter JF. Idiopathic splenic vein stenosis (a cause of gastric variceal hemorrhage). South Med J. 2000;93:812–814
  38. Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Suga T. Gastric varices with splenic vein occlusion treated by splenic arterial embolization. J Gastroenterol. 2000;35:290–295
  39. Garcia-Tsao G, Groszmann RJ, Fischer G, onn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–424
  40. Adamsons RJ, Butt K, Dennis CR, Kinkhabwala M, Moskowitz H, Gordon D, et al. Prognostic significance of portal pressure in patients with bleeding esophageal varices. Surg Gynecol Obstet. 1977;145:353–356
  41. Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980;79:1139–1144
  42. McLeod MK, Eckhauser FE, Turcotte JG. Significance of corrected sinusoidal pressure (CSP) in patients with cirrhosis and portal hypertension. Ann Surg. 1981;194:562–567
  43. Tripathi D, Therapondos G, Jackson E, Redhead DN, Hayes PC. The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices (clinical and haemodynamic correlations). Gut. 2002;51:270–274
  44. Feu F, Garcia-Pagan JC, Bosch J, Luca A, Teres J, Escorssell A, et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet. 1995;346:1046–1047
  45. Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, et al. Hemodynamic events in a prospective randomized trial of propranalol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990;99:1401–1407
  46. D’Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension (a meta-analytic review). Hepatology. 1995;22:332–354
  47. Ohnishi K, Nakayama T, Koen H, Saito M, Chin N, Terabayashi H, et al. Interrelationship between type of spontaneous portal systemic shunt and portal vein pressure in patients with liver disease. Am J Gastroenterol. 1985;80:561–564
  48. Sanyal AJ, Freedman AM, Luketic VA, Purdum PP, Shiffman ML, DeMeo J, et al. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology. 1997;112:889–898
  49. Polio J, Groszmann RJ. Hemodynamic factors involved in the development and rupture of esophageal varices (a pathophysiologic approach to treatment). Semin Liver Dis. 1986;6:318–331
  50. McCormick PA, Jenkins SA, McIntyre N, Burroughs AK. Why portal hypertensive varices bleed and bleed (a hypothesis). Gut. 1995;36:100–103
  51. Mahal TC, Groszmann RJ. Pathophysiology of portal hypertension and variceal bleeding. Surg Clin North Am. 1990;70:251–266
  52. Arakawa M, Masuzaki T, Okuda K. Pathology of fundic varices of the stomach and rupture. J Gastroenterol Hepatol. 2002;17:1064–1069
  53. Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–312
  54. Bosch J, Garcia-Pagan JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141–156
  55. Korula J, Chin K, Ko Y, Yamada S. Demonstration of two distinct subsets of gastric varices. Observations during a seven-year study of endoscopic sclerotherapy. Dig Dis Sci. 1991;36:303–309
  56. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices . Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319:983–989
  57. Palmer ED, Brick IB. Correlation between severity of esophageal varices in portal cirrhosis and their propensity toward hemmorrhage. Gastroenterology. 1956;30:85–90
  58. Beppu K, Inokuchi K, Koyanagi N, Nakayama S, Sakata H, Kitano S, et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc. 1981;27:213–218
  59. Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology. Gut. 2000;46(Suppl 3–4):III1, III15
  60. Merkel C, Zoli M, Siringo S, van Buuren H, Magalotti D, Angeli P, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis (a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index). Am J Gastroenterol. 2000;95:2915–2920
  61. Zoli M, Merkel C, Magalotti D, Gueli C, Grimaldi M, Gatta A, et al. Natural history of cirrhotic patients with small esophageal varices (a prospective study). Am J Gastroenterol. 2000;95:503–508
  62. De BK, Ghoshal UC, Das AS, Nandi S, Mazumder DN. Portal hypertensive gastropathy and gastric varices before esophageal variceal sclerotherapy and after obliteration. Indian J Gastroenterol. 1998;17:10–12
  63. Sarin SK, Jain AK, Lamba GS, Gupta R, Chowdhary A. Isolated gastric varices (prevalence, clinical relevance and natural history). Dig Surg. 2003;20:42–47
  64. Takase Y, Ozaki A, Orii K, Nagoshi K, Okamura T, Iwasaki Y. Injection sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery. 1982;92:474–479
  65. Jorge AD, Adam J, Seittert L, Segal E. Sclerotherapy of oesophageal varices—an Argentinian experience. Endoscopy. 1983;15(Suppl 1):141–143
  66. Hedberg SE, Fowler DL, Ryan RLR. Injection sclerotherapy of oesophageal varices using ethanolamine oleate. Am J Surg. 1982;143:426–431
  67. Graham DY, Smith JL. The course of patients after variceal haemorrhage. Gastroenterology. 1981;80:800–809
  68. Kitano S, Terblanche J, Khan D, Bornman PC. Venous anatomy of the lower oesophagus in portal hypertension (practical implications). Br J Surg. 1986;73:525–531
  69. Grobe JI, Kozarek RA, Sanowski RA, LeGrand J, Kovac A. Venography during endoscopic injection sclerotherapy of oesophageal varices. Gastrointest Endosc. 1984;30:6–8
  70. Grace ND, Groszmann RJ, Garcia-Tsao G, Burroughs AK, Pagliaro L, Makuch RW, et al. Portal hypertension and variceal bleeding (an AASLD single topic symposium). Hepatology. 1998;28:868–880
  71. de Franchis R. Updating consensus in portal hypertension (report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension). J Hepatol. 2000;33:846–852
  72. Hayes PC, Davis JM, Lewis JA, Bouchier IA. Meta-analysis of value of propranalol in variceal haemorrhage. Lancet. 1990;336:153–156
  73. Conn HO, Grace ND, Bosch J, Groszmann RJ, Rodes J, Wright SC, et al. Propranalol in the prevention of the first hemorrhage from esophagogastric varices (a multicenter, randomized clinical trial). Hepatology. 1991;13:902–912
  74. Poynard T, Cales P, Pasta L, Ideo G, Pascal JP, Pagliaro L, et al. Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. N Engl J Med. 1991;324:1532–1538
  75. Pascal JP, Cales P. Propranalol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med. 1987;317:856–861
  76. Ideo G, Bellati G, Fesce E, Grimoldi D. Nadalol can prevent the first gastrointestinal bleeding in cirrhotics (a prospective, randomized study). Hepatology. 1988;8:6–9
  77. Matsumoto A, Matsumoto H, Hamamoto N, Kayazawa M. Management of gastric fundal varices associated with a gastrorenal shunt. Gut. 2001;48:440–441
  78. Matsumoto A, Matsumoto H, Inokuchi H. Isolated gastric fundal varices (a challenging issue). Am J Gastroenterol. 2002;97:2930–2931
  79. Jalan R, Hayes PC. Management of gastric fundal varices associated with a gastrorenal shunt. (reply) Gut. 2001;48:440–441
  80. Zhou Y, Qiao L, Wu J, Hu H, Xu C. Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy (a controlled study). J Gastroenterol Hepatol. 2002;17:973–979
  81. Wu CY, Yeh HZ, Chen GH. Pharmacologic efficacy in gastric variceal rebleeding and survival (including multivariate analysis). J Clin Gastroenterol. 2002;35:127–132
  82. Bleichner G, Boulanger R, Squara P, Sollet JP, Parent A. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. Br J Surg. 1986;73:724–726
  83. Goulis J, Armonis A, Patch D, Sabin C, Greenslade L, Burroughs AK. Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhage. Hepatology. 1998;27:1207–1212
  84. Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients (a prospective study). Gastroenterology. 1995;108:1828–1834
  85. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding (a meta-analysis). Hepatology. 1999;29:1655–1661
  86. Hsieh WJ, Lin HC, Hwang SJ, Hou MC, Lee FY, Chang FY, et al. The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. Am J Gastroenterol. 1998;93:962–966
  87. Panes J, Teres J, Bosch J, Rodes J. Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices. Results in 151 consecutive episodes. Dig Dis Sci. 1988;33:454–459
  88. Teres J, Cecilia A, Bordas JM, Rimola A, Bru C, Rodes J. Esophageal tamponade for bleeding varices. Controlled trial between the Sengstaken-Blakemore tube and the Linton-Nachlas tube. Gastroenterology. 1978;75:566–569
  89. Stray N, Jacobsen CD, Rosseland A. Injection sclerotherapy of bleeding oesophageal and gastric varices using a flexible endoscope. Acta Med Scand. 1982;211:125–129
  90. Paquet KJ, Feusener H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices. Hepatology. 1985;5:580–583
  91. Sarin SK, Sachdev G, Nanda R, Misra SP, Broor SL. Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg. 1988;75:747–750
  92. Millar AJ, Brown RA, Hill ID, Rode H, Cywes S. The fundal pile (bleeding gastric varices). J Pediatr Surg. 1991;26:707–709
  93. Sarin SK, Govil A, Jain AK, Guptan RC, Issar SK, Jain M, et al. Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices (influence on gastropathy, gastric varices and variceal recurrence). J Hepatol. 1997;26:826–832
  94. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–1015
  95. Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18:25–26
  96. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33:1060–1064
  97. Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices (a nonrandomized study). Endoscopy. 1995;27:349–354
  98. Akahoshi T, Hashizume M, Shimabukuro R, Tanoue K, Tomikawa M, Okita K, et al. Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding (a 10-year experience). Surgery. 2002;131:S176–S181
  99. Dhiman RK, Chawla Y, Taneja S, Biswas R, Sharma TR, Dilawari JB. Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate. J Clin Gastroenterol. 2002;35:222–227
  100. Huang YH, Yeh HZ, Chen GH, Chang CS, Wu CY, Poon SK, et al. Endoscopic treatment for bleeding gastric varices by N-butyl-2 cyanoacrylate (Histoacryl) injection (long-term efficacy and safety). Gastrointest Endosc. 2000;52:160–167
  101. Yang WL, Tripathi D, Therapondos G, Todd A, Hayes PC. Endoscopic use of human thrombin in bleeding gastric varices. Am J Gastroenterol. 2002;97:1381–1385
  102. Williams SGJ, Peters RA, Westaby D. Thrombin—an effective treatment for gastric variceal haemorrhage. Gut. 1994;35:1287–1289
  103. Heneghan MA, Byrne A, Harrison PM. An open pilot study of the effects of a human fibrin glue for endoscopic treatment of patients with acute bleeding from gastric varices. Gastrointest Endosc. 2002;56:422–426
  104. Miyazaki S, Yoshida T, Harada T, Shigemitsu T, Takeo Y, Okita K. Injection sclerotherapy for gastric varices using N-butyl-2- cyanoacrylate and ethanolamine oleate. Hepatogastroenterology. 1998;45:1155–1158
  105. Lee YT, Chan FK, Ng EK, Leung VK, Law KB, Yung MY, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52:168–174
  106. See A, Florent C, Lamy P, Levy VG, Bouvry M. Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients. Gastroenterol Clin Biol. 1986;10:604–607
  107. Roesch W, Rexroth G. Pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy. 1998;30:S89–S90
  108. Thakeb F, Salama Z, Salama H, Abdel Raouf T, Abdel Kader S, Abdel Hamid H. The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding esophagogastric varices. Endoscopy. 1995;27:358–364
  109. Verger P, Blais J, Gruau M, Haffaf Y. [Retrogastric abscess secondary to gastric varices obturation with cyanoacrylate]. Gastroenterol Clin Biol. 1998;22:248–249
  110. Cheng PN, Sheu BS, Chen CY, Chang TT, Lin XZ. Splenic infarction after histoacryl injection for bleeding gastric varices. Gastrointest Endosc. 1998;48:426–427
  111. Shim CS, Cho YD, Kim JO, Bong HK, Kim YS, Lee JS, et al. A case of portal and splenic vein thrombosis after Histoacryl injection therapy in gastric varices. Endoscopy. 1996;28:461
  112. Hwang SS, Kim HH, Park SH, Kim SE, Jung JI, Ahn BY, et al. N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comput Assist Tomogr. 2001;25:16–22
  113. Binmoeller KF. Glue for gastric varices (some sticky issues). Gastrointest Endosc. 2000;52:298–301
  114. Binmoeller KF, Soehendra N. New haemostatic techniques (histoacryl injection, banding, endoloop ligation and haemoclipping). Baillieres Clin Gastroenterol. 1999;13:85–96
  115. Lee MS, Cho JY, Cheon YK, Ryu CB, Moon JH, Cho YD, et al. Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices. Gastrointest Endosc. 2002;56:83–88
  116. Harada T, Yoshida T, Shigemitsu T, Takeo Y, Tada M, Okita K. Therapeutic results of endoscopic variceal ligation for acute bleeding of oesophageal and gastric varices. J Gastroenterol Hepatol. 1997;12:331–335
  117. Yoshida T, Hayashi N, Suzumi N, Miyazaki S, Terai S, Itoh T, et al. Endoscopic ligation of gastric varices using a detachable snare. Endoscopy. 1994;26:502–505
  118. Cipolletta L, Bianco MA, Rotondano G, Piscopo R, Prisco A, Garofano ML. Emergency endoscopic ligation of actively bleeding gastric varices with a detachable snare. Gastrointest Endosc. 1998;47:400–403
  119. Shiha G, El-Sayed SS. Gastric variceal ligation (a new technique). Gastrointest Endosc. 1999;49:437–441
  120. Lee MS, Shim CS. Is endoscopic ligation therapy with large detachable snares and elastic bands really safe and effective?. Response Gastrointest Endosc. 2003;57:439–440
  121. Lo GH, Lai KH. Is endoscopic ligation therapy with large detachable snares and elastic bands really safe and effective?. Gastrointest Endosc. 2003;57:438–439
  122. Chun HJ, Hyun JH. A new method of endoscopic variceal ligation-injection sclerotherapy (EVLIS) for gastric varices. Korean J Intern Med. 1995;10:108–119
  123. Yoshida T, Harada T, Shigemitsu T, Takeo Y, Miyazaki S, Okita K. Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O-ring ligation. J Gastroenterol Hepatol. 1999;14:730–735
  124. Yoshida H, Onda M, Tajiri T, Mamada Y, Taniai N, Mineta S, et al. New techniques (combined endoscopic injection sclerotherapy and ligation for acute bleeding from gastric varices). Hepatogastroenterology. 2002;49:932–934
  125. Papatheodoridis GV, Goulis J, Leandro G. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding. Hepatology. 1999;30:612–622
  126. Escorsell A, Banares R, Garcia-Pagan JC, Gilabert R, Moitinho E, Piqueras B, et al. TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis (a randomized controlled trial). Hepatology. 2002;35:385–392
  127. Stanley AJ, Jalan R, Forrest EH, Redhead DN, Hayes PC. Long-term follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension (results in 130 patients). Gut. 1996;39:479–485
  128. LaBerge JM, Somberg KA, Lake JR, Gordon RL, Kerlan RK, Ascher NL, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding (results in 90 patients). Gastroenterology. 1995;108:1143–1151
  129. Jalan R, Elton RA, Redhead DN, Finlayson ND, Hayes PC. Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. J Hepatol. 1995;23:123–128
  130. Song HG, Lee HC, Park YH, Jung S, Chung YH, Lee YS, et al. [Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices]. Taehan Kan Hakhoe Chi. 2002;8:448–457
  131. Chalasani N, Clark WS, Martin LG, Kamean J, Khan MA, Patel NH, et al. Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology. 2000;118:138–144
  132. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–871
  133. Barange K, Peron JM, Imani K, Otal P, Payen JL, Rousseau H, et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30:1139–1143
  134. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. “Salvage” transjugular intrahepatic portosystemic shunts (gastric fundal compared with esophageal variceal bleeding). Gastroenterology. 1998;114:981–987
  135. Rees CJ, Nylander DL, Thompson NP, Rose JD, Record CO, Hudson M. Do gastric and oesophageal varices bleed at different portal pressures and is TIPS an effective treatment?. Liver. 2000;20:253–256
  136. Stanley AJ, Jalan R, Ireland HM, Redhead DN, Bouchier IA, Hayes PC. A comparison between gastric and oesophageal variceal haemorrhage treated with transjugular intrahepatic portosystemic stent shunt (TIPSS). Aliment Pharmacol Ther. 1997;11:171–176
  137. Spahr L, Dufresne M-P, Bui B. Efficacy of TIPS in the prevention of rebleeding from esophageal and fundal varices (a comparative study). (abstr) Hepatology. 1995;22:296A
  138. Casado M, Bosch J, Garcia-Pagan JC, Bru C, Banares R, Bandi JC, et al. Clinical events after transjugular intrahepatic portosystemic shunt (correlation with hemodynamic findings). Gastroenterology. 1998;114:1296–1303
  139. Lind CD, Malisch TW, Chong WK, Richards WO, Pinson CW, Meranze SG, et al. Incidence of shunt occlusion or stenosis following transjugular intrahepatic portosystemic shunt placement. Gastroenterology. 1994;106:1277–1283
  140. Pomier-Layrargues G, Villeneuve J-P, Deschenes M, Bui B, Perrault P, Fenyves D, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis (a randomised trial). Gut. 2001;48:390–396
  141. Schlegel PM, Tombach B, Reimer P, Vestring T, Menzel J, Moller HE, et al. [The value of magnetic resonance imaging (MRI) for the follow-up of patients with transjugular intrahepatic portosystemic shunts (TIPS)]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2002;174:224–230
  142. Hansmann HJ, Noldge G, Leutloff U, Radeleff B, Sauer P, Richter GM. [Radiologic after-care of transjugular intrahepatic stent shunt (TIPSS)]. Radiologe. 2001;41:884–890
  143. Grace ND. TIPS (the long and the short of it). Gastroenterology. 1997;112:1040–1043
  144. Ono N, Toyonaga A, Nishimura H, Hayabuchi N, Tanikawa K. Evaluation of magnetic resonance angiography on portosystemic collaterals in cirrhotic patients. Am J Gastroenterol. 1997;92:1515–1519
  145. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Urgent transjugular retrograde obliteration for prophylaxis of rebleeding from gastric varices in patients with a spontaneous portosplenorenal shunt. Dig Surg. 2000;17:23–28
  146. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery. 2001;129:414–420
  147. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001;12:327–336
  148. Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349–356
  149. Kato T, Uematsu T, Nishigaki Y, Sugihara J, Tomita E, Moriwaki H. Therapeutic effect of balloon-occluded retrograde transvenous obliteration on portal-systemic encephalopathy in patients with liver cirrhosis. Intern Med. 2001;40:688–691
  150. Oho K, Iwao T, Sakai T, Tayama C, Sato M, Nakano R, et al. Randomized prospective trial for bleeding fundal varices (endoscopic sclerotherapy versus transvenous obliteration). Gastroenterology. 1997;112:A1351
  151. Matsumoto A, Hamamoto N, Kayazawa M. Balloon endoscopic sclerotherapy, a novel treatment for high-risk gastric fundal varices (a pilot study). Gastroenterology. 1999;117:515–516
  152. Kiyosue H, Matsumoto S, Onishi R, Okahara M, Hori Y, Yamada Y, et al. [Balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices (therapeutic results and problems]). Nippon Igaku Hoshasen Gakkai Zasshi. 1999;59:12–19
  153. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11:51–58
  154. Ohishi W, Kitamoto M, Takaishi H, Takahashi S, Tsuji K, Masanaga T, et al. [A case of gastric varices treated with B-RTO followed by 3D-CT angiography]. Nippon Shokakibyo Gakkai Zasshi. 1998;95:1018–1021
  155. Kin H, Kubota Y, Tsuji K, Takeuchi Y, Takaoka M, Ogura M, et al. MR imaging in the evaluation of the therapeutic effect of B-RTO for gastric varices. Hepatogastroenterology. 1998;45:677–683
  156. Hamamoto N, Matsumoto A, Nomura T, Kayazawa M, Hirata I, Morikawa H, et al. Treatment of gastric fundal varices by balloon endoscopic sclerotherapy. Gastrointest Endosc. 1999;49:115–118
  157. Shiba M, Higuchi K, Nakamura K, Itani A, Kuga T, Okazaki H, et al. Efficacy and safety of balloon-occluded endoscopic injection for sclerotherapy as a prophylactic treatment for high-risk gastric varices (a prospective, randomized, comparative clinical trial). Gastrointest Endosc. 2002;56:522–528
  158. Shiba M, Higuchi K, Nakamura K, Kuga T, Hamasaki N, Ando K, et al. A case of huge gastric varices successfully treated with endoscopic injection sclerotherapy with occlusion of both supplying and draining veins with balloons. Gastrointest Endosc. 2000;52:104–107
  159. Jackson FC, Perrin EB, Smith AG, Dagradi AE, Nadal HM. A clinical investigation of the portacaval shunt II. Survival analysis of the prophylactic operation. Am J Surg. 1968;115:22–42
  160. Conn HO, Lindenmuth WW, May CJ, Ramsby GR. Prophylactic portacaval anastomosis in cirrhotic patients with esophageal varices. N Engl J Med. 1965;272:1255–1263
  161. Thomas PG, D’Cruz AJ. Distal splenorenal shunting for bleeding gastric varices. Br J Surg. 1994;81:241–244

PII: S0016-5085(04)00148-9

doi: 10.1053/j.gastro.2004.01.058

Gastroenterology
Volume 126, Issue 4 , Pages 1175-1189 , April 2004

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