Treatment of Gastric Varices

Gastric varices are an uncommon complication in patients with cirrhosis and portal hypertension. Significant advances have been made over the past 5 years with new classification and treatment paradigms in gastric variceal management. We will review the most up-to-date literature on classification, approach, and therapeutic options currently utilized for gastric variceal management.

The American Gastroenterological Association recently proposed a simpler classification system that better aligns with existing treatment options for gastric varices. Moreover, there has been increasing literature introducing endoscopic ultrasound-guided coil embolization-based therapies as well as new outcomes data for existing endoscopic and endovascular therapies.

Per our institutional experience and literature review, we advise an algorithmic approach starting with medical management of gastric varices followed by careful consideration of the various endoscopic and endovascular therapies available based on patient profile, bleeding acuity, and availability of local expertise and procedural offerings.