Trikudanathan Guru, Rahimi Erik F, Bhatt Amit, Bucobo Juan Carlos, Chandrasekhara Vinay, Copland Andrew P, Han Samuel, Kahn Allon, Krishnan Kumar, Kumta Nikhil A, Lichtenstein David R, Obando Jorge V, Pannala Rahul, Parsi Mansour A, Saumoy Monica, Trindade Arvind J, Yang Julie, Law Ryan J
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas, USA.
Gastrointest Endosc. 2025 Mar;101(3):496-510. doi: 10.1016/j.gie.2024.06.038. Epub 2024 Oct 31.
Gastric variceal bleeding occurs less commonly than bleeding from esophageal varices (EVs), although it is associated with higher morbidity and mortality. Bleeding from gastroesophageal varices type 1 (GOV1) is treated like EVs. In contrast, other forms of gastric variceal bleeding, including gastroesophageal varices type 2 (GOV2) and isolated gastric varices types 1 (IGV1) and 2 (IGV2), are treated with varying endoscopic approaches. Nonendoscopic methods include transjugular intrahepatic portosystemic shunt (TIPS) or balloon-occluded retrograde transvenous obliteration (BRTO). This technology report focuses on endoscopic management of gastric varices (GVs).
The MEDLINE database was searched through August 2022 for relevant articles by using key words such as gastric varices, glue, cyanoacrylate, thrombin, sclerosing agents, band ligation, topical hemostatic spray, coils, EUS, TIPS, and BRTO. The article was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee and approved by the Governing Board of the ASGE.
Endoscopic injection with cyanoacrylate (CYA) glue has been the primary endoscopic method to treat GVs. EUS-guided angiotherapy with CYA glue and coil embolization has emerged as an alternative method enabling improved detection of GVs with a high technical success for targeting and obliterating GVs. Combining CYA glue with coil therapy allows the coil to act as a scaffold for the glue, reducing the risk of glue embolization and improving outcomes. Alternative injectates or topical treatments have been described but remain poorly studied.
The mainstay paradigm for the endoscopic management of gastric variceal bleeding is the injection of CYA glue. The published success of EUS-guided angiotherapy using CYA glue with or without embolization coils has increased our treatment armamentarium.
胃静脉曲张出血的发生率低于食管静脉曲张（EV）出血，但其发病率和死亡率更高。1型胃食管静脉曲张（GOV1）出血的治疗方法与EV出血相同。相比之下，其他形式的胃静脉曲张出血，包括2型胃食管静脉曲张（GOV2）以及1型（IGV1）和2型（孤立性胃静脉曲张，IGV2），则采用不同的内镜治疗方法。非内镜方法包括经颈静脉肝内门体分流术（TIPS）或球囊闭塞逆行静脉栓塞术（BRTO）。本技术报告重点关注胃静脉曲张（GV）的内镜治疗。
通过检索MEDLINE数据库，查找截至2022年8月的相关文章，使用的关键词包括胃静脉曲张、胶水、氰基丙烯酸酯、凝血酶、硬化剂、套扎术、局部止血喷雾剂、线圈、超声内镜、TIPS和BRTO。本文由美国胃肠内镜学会（ASGE）技术委员会起草、审核和编辑，并经ASGE理事会批准。
内镜下注射氰基丙烯酸酯（CYA）胶水一直是治疗GV的主要内镜方法。超声内镜引导下使用CYA胶水进行血管内治疗和线圈栓塞术已成为一种替代方法，能够更好地检测GV，在靶向和闭塞GV方面技术成功率较高。将CYA胶水与线圈治疗相结合，可使线圈作为胶水的支架，降低胶水栓塞的风险并改善治疗效果。已描述了其他注射剂或局部治疗方法，但相关研究较少。
胃静脉曲张出血内镜治疗的主要模式是注射CYA胶水。已发表的关于使用CYA胶水联合或不联合栓塞线圈进行超声内镜引导下血管内治疗的成功案例增加了我们的治疗手段。
