The evidence-based advice includes the following:
- Initial therapy for bleeding gastric varices should focus on acute hemostasis for hemodynamic stabilization with a plan for further diagnostic evaluation and/or transfer to a tertiary care center with expertise in gastric varices management.
- Following initial endoscopic hemostasis, cross-sectional (magnetic resonance or CT) imaging with portal venous contrast phase should be obtained to determine vascular anatomy, including the presence or absence of portosystemic shunts and gastrorenal shunts.
- Determination of definitive therapy for bleeding gastric varices should be based on endoscopic appearance of the gastric varix, the underlying vascular anatomy, presence of comorbid portal hypertensive complications, and available local resources. This is ideally done via a multidisciplinary discussion between the GI or hepatologist and the interventional radiologist.
In this AGA Clinical Practice Update Expert Review, the experts also suggest adding an estimate of variceal size and high-risk stigmata (discolored marks, platelet plugs) to the Sarin classification when describing patients’ gastric varices.
Read the full list of the best practice advice statements in the AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review.
