Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China.
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic-IDIBAPS, CIBEREHD, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain.
Liver Int. 2022 Jun;42(6):1250-1258. doi: 10.1111/liv.15181. Epub 2022 Feb 21.
Gastro-oesophageal varices are the major clinical manifestations of cirrhosis and portal hypertension. Although less frequent than oesophageal varices (EV), bleeding from gastric varices (GV) is generally more severe and associated with higher mortality and a greater risk to rebleed. According to Sarin's classification, GVs are categorized into four types based on their location within the stomach and relationship with EV. Currently, treatment options for the management of GV include beta-blockers, endoscopic band ligation, endoscopic cyanoacrylate injection, EUS-guided coil/cyanoacrylate injection, transjugular intrahepatic portosystemic shunts and balloon-occluded retrograde transvenous obliteration. The best treatment strategy of GV remains controversial because of the heterogeneity of GV, lack of high-quality data and suboptimal trial design of the studies available. The proper treatment algorithm may require adequate endoscopic and imaging evaluation by a multidisciplinary team with multiple treatment options available. This review describes the hemodynamic features of GV, pharmacological, endoscopic and interventional radiological treatment options for GV.
胃食管静脉曲张是肝硬化和门静脉高压症的主要临床表现。虽然胃静脉曲张 (GV) 比食管静脉曲张 (EV) 少见，但出血通常更为严重，死亡率更高，再出血风险更大。根据 Sarin 分类，根据胃内位置和与 EV 的关系，GV 分为四型。目前，GV 管理的治疗选择包括β受体阻滞剂、内镜套扎、内镜氰基丙烯酸酯注射、EUS 引导下线圈/氰基丙烯酸酯注射、经颈静脉肝内门体分流术和球囊阻塞逆行经静脉闭塞术。由于 GV 的异质性、缺乏高质量数据和现有研究的试验设计不理想，GV 的最佳治疗策略仍存在争议。适当的治疗方案可能需要多学科团队进行充分的内镜和影像学评估，并提供多种治疗选择。本文综述了 GV 的血流动力学特征，以及 GV 的药物治疗、内镜治疗和介入放射学治疗选择。
