Endoscopy 2018; 50(04): S8
DOI: 10.1055/s-0038-1637046
ESGE Days 2018 oral presentations
20.04.2018 – GI bleeding
Georg Thieme Verlag KG Stuttgart · New York

RISK STRATIFICATION FOR THE TREATMENT OF GASTRIC VARICES SECONDARY TO PORTAL HYPERTENSION

Y Tseng
1   Zhongshan Hospital Fudan University, Gastroenterology, Shanghai, China
,
L Ma
2   Zhongshan Hospital Fudan University, Endoscopy Center, Shanghai, China
,
S Chen
3   Zhongshan Hospital Fudan University, Gastroenterology, Endoscopy Center, Evidence-Based Medicine Center, Shanghai, China
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Background & aims:

Gastroesophageal variceal hemorrhage is a common complication associated with portal hypertension. Even with appropriate secondary prophylactic therapy the rate of variceal hemorrhage and its associated mortality remain concerning, especially in patients with gastric varices. Current guidelines provide well-established recommendations for esophageal varices, while that of gastric varices remain scarce and lack evidential strength. This study is aimed at identifying a feasible risk stratification method based on imaging findings to evaluate patient response to cyanoacrylate injection for the treatment of gastric varices.

Methods:

A prospective cohort study included patients diagnosed with gastric varices admitted to a tertiary medical center seeking initial secondary prophylactic treatment for variceal hemorrhage. Prior to endoscopic therapy, a CTA of the portal system and endoscopic ultrasound were performed on all subjects to evaluate extraluminal collaterals. Patients were prospectively followed for at least 12 months to assess the association between extraluminal phenomena and the recurrence of variceal rebleed.

Results:

A total of 102 subjects were enrolled in the present study, among which, 66.7% had GOV Type 2, 27.5% had GOV Type 1 and 5.9% had IGV Type 1. All gastric varices were uniformly treated with cyanoacrylate injection, while concurrent esophageal varices were treated with either banding or sclerotherapy. During the 12 months follow-up, 33.3% patients experienced variceal bleed. A Kaplan-Meier curve demonstrated a significant association between incidence of variceal rebleed and presence of para-gastric veins on both CTA and EUS (p < 0.01).

Conclusions:

The presence of para-gastric vein is a characteristic of poor response to endoscopic therapy for treatment of gastric varices with tissue adhesive. Early identification of this subgroup necessitates a change in course of treatment, which can improve overall patient outcome.

Keywords:

Gastric varices; cyanoacrylates; risk stratification; portal hypertension