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Digestive Disease Interventions 2023; 07(04): 256-265
DOI: 10.1055/s-0043-1771305
Review Article

Management of Gastric Varices: IR Perspective

Mario Dervishi 
1   Division of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
,
Christopher Sutter
1   Division of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
,
Rakesh K. Varma
2   Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract

Gastric varices are a sequela of portal hypertension. If left untreated, life-threatening bleeding can occur. While endoscopic treatment is traditionally considered as a first-line interventional option, endovascular techniques have emerged to become the superior option in certain clinical scenarios, either as a first-line therapy or a salvage therapy. Endovascular techniques for managing gastric varices include transjugular intrahepatic portosystemic shunt (TIPS) placement, balloon-occluded retrograde transvenous obliteration (BRTO), coil, and plug-assisted retrograde transvenous obliteration, as well as a combination of both. Studies have shown that endovascular techniques can effectively control bleeding from gastric varices, with high success rates and low complication rates, and significantly reduce recurrence. TIPS placement has shown to be more effective in controlling bleeding from gastroesophageal varices, while BRTO, coil, or plug-assisted embolizations are more suitable for patients with isolated gastric varices. Endovascular interventions are a valuable option for managing gastric varices, especially in patients who are not candidates for endoscopic treatment or who have failed previous endoscopic interventions. In this two-part series editorial, we aim to initially review the complex anatomy and classification of gastric varices, medical management, and current endovascular interventional techniques, and how they compare with one another. In part 2, we draw a parallel between endovascular versus endoscopic techniques, and highlight and critically review current literature as it pertains to gastric variceal management.

Keywords

gastric varices - endovascular techniques - TIPS - BRTO - interventional radiology


Publication History

Received: 20 March 2023

Accepted: 12 June 2023

Article published online:
28 July 2023

© 2023. Thieme. All rights reserved.

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