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Gastric Varices: An Updated Review of Management

Irani, Shayan MD; Kowdley, Kris MD; Kozarek, Richard MD

Journal of Clinical Gastroenterology: February 2011 - Volume 45 - Issue 2 - p 133–148
doi: 10.1097/MCG.0b013e3181fbe249

Gastric varices are less prevalent than esophageal varices, but are associated with an increased mortality with each bleeding episode. This review describes the portal hemodynamics, classification, and management of gastric varices. Management options are outlined based on the most recent literature and according to the clinical presentation of acutely bleeding gastric varices, secondary prophylaxis after bleeding, and primary prophylaxis against an initial bleed. The optimal treatment remains controversial because of the lack of data from large controlled trials. We suggest an algorithm for the management based on the etiology of the gastric varices, severity of the underlying liver disease, and local availability and expertise.

Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA

There are no conflict of interest disclosures or declaration of funding sources to declare.

Reprints: Shayan Irani, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Avenue, MS: C3-GAS, Seattle, WA 98111 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.