gastric varices

Introduction

See esophageal varices

Etiology

• cirrhosis

Epidemiology

• 20% of patients with cirrhosis

Radiology

• contrast enhanced abdominal CT to delineate anatomy of abdominal vasculature
  • identifies splenic vein thrombosis, portal vein thrombosis & collateral circulation around thrombosed vein (abdominal ultrasound would not)

Management

• octreotide to reduce portal hypertension
• broad spectum antibiotics to reduce infectious complications
• treatment of gastric varices along the greater curvature of the stomach depends upon anatomy of the abdominal vasculature
  • for isolated gastric varices due to splenic vein thrombosis, splenectomy can reduce the gastric varices
  • if the portal vein is patent & a suitable splenorenal shunt is available, retrograde transvenous balloon obliteration of varices may be considered
  • if anatomy of hepatic vein & portal vein is favorable, TIPS may be an option
• gastric fundus varices are more frequent with portal vein thrombosis or splenic vein thrombosis
  • endovascular obliteration is an option in patients with adequate collateral circulation
• gastric varices in the gastric fundus are not amenable to band ligation
• gastric varices in the gastric cardia (esophagus into lesser curvature) are amenable to band ligation

More general terms

• varicose vein (varix)
• gastric disease
• portosystemic shunt

Additional terms

• esophageal varices