Merican, I; Burroughs, AK; (1992) Gastric varices. European Journal of Gastroenterology and Hepatology , 4 (7) 511 - 520.
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Purpose: To update information concerning the prevalence, prognostic significance and treatment of gastric varices. Data identification and study selection: A literature search was conducted of relevant papers, including those not in English. Results of data analysis: There is a wide variation between the prevalence of gastric varices and incidence of gastric variceal bleeding. The most useful classification divides gastric varices into those at the fundus and those at the gastro-oesophageal junction as these factors influence prognosis and treatment. Recent series treated with conventional sclerotherapy have shown good results for junctional varices but poor results and increased mortality for fundal varices. Although injection of tissue adhesive appears to be very effective for fundal varices, there is a wide reported range of efficacy, perhaps caused by technical factors. Conclusion: Gastric variceal bleeding has a poorer prognosis than bleeding from oesophageal varices especially when arising from the fundus. Varices on the lesser curve can be treated in the same way as oesophageal varices but treatment of fundal varices is still controversial. Uncontrolled studies with injection of tissue adhesive report good results but surgery remains the first treatment option in many centres. A controlled trial is needed.
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