Gastroesophageal
varices bleeding is a major complication in patients with
cirrhosis.
Gastric varices (GVs) occur in approximately 20% of patients with
portal hypertension. However, GV
bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV)
bleeding. The best strategy for managing acute GV
bleeding is similar to that of acute EV
bleeding, which involves airway protection, hemodynamic stabilization, and
intensive care.
Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as
terlipressin or
somatostatin should be used when GV
bleeding is suspected. Routine use of prophylactic
antibiotics reduces
bacterial infection and lowers rebleeding rates. By administering endoscopic
cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV
bleeding is approximately 10-30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of
cyanoacrylate is superior to
sclerotherapy and band
ligation, and has remained the treatment of choice for treating acute GV
bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as
thrombin injection, transjugular intrahepatic
portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV
bleeding. However, randomized controlled trials are needed to compare the efficacy of these
therapies with
cyanoacrylate.