Gastric varices are dilated submucosal veins in the stomach.

Gastric varices are typically induced by portal hypertension, which is commonly a consequence of cirrhosis. Other causes include thrombosis of intra-abdominal vessels, complications of pancreatitis, and intra-abdominal tumors.

Clinical presentation

---

When symptomatic gastric varices usually present acutely and dramatically with upper GI hemorrhage. The symptoms can include:

• hematemesis, or vomiting blood
• melena, or passing black, tarry stools
• passing marroon stools or frank blood in the stools

Oftentimes gastric varices are found in asymptomatic patients with portal hypertension on screening endoscopy.

Physical examination may reveal signs of portal hypertension or chronic liver disease, including ascites (fluid in the abdomen), splenomegaly (enlarged spleen), dilated abdominal veins, Terry's nails, or spider nevi.

Laboratory testing usually shows anemia and often thrombocytopenia, or a low platelet count. If cirrhosis is present, there may be coagulopathy manifested by a prolonged INR.

Diagnosis and classification

---

Diagnosis of gastric varices is often made at the time of upper endoscopy.

The Sarin classification of gastric varices identifies four different anatomical types of gastric varices, which differ in terms of treatment modalities.

Treatment

---

Initial treatment of bleeding from gastric varices focuses on resuscitation, much as with esophageal varices. This includes administration of fluids, blood products, and antibiotics.

The mainstay of acute treatment of bleeding from gastric varices is endoscopic injection of cyanoacrylate, known as gastric variceal obliteration or GVO. Cyanoacrylate, a common component in super glue is often mixed 1:1 with lipiodol to prevent polymerization in the endoscopy delivery optics, and to show on radiographic imaging. GVO is usually performed is specialized therapeutic endoscopy centers. Complications include sepsis, embolization of glue, and obstruction from polymerization in the lumen of the stomach.

Other techniques for refractory bleeding include:

• Transjugular intrahepatic portosystemic shunts (TIPS)
• Balloon occluded retrograde transvenous obliteration techniques (BORTO)
• Gastric variceal ligation, although this modality is falling out of favour
• Intra-gastric balloon tamponade as a bridge to further therapy
  • a caveat is that a larger balloon is required to occupy the fundus of the stomach where gastric varices commonly occur
• Liver transplantation

Gastroenterology