2, 8 Those cardio-fundal varices which have higher risk of bleeding should be controlled by EVO instead. Although GOV1 is most common type of GV (75% of GV), the risk of bleeding is relatively lower than other types of GV: IGV1 (78%)>GOV2 (55%)>GOV1 (10%). EV extending into fundus along greater curvature (GOV2) and isolated GV located in fundus (IGV1), which commonly referred to as cardio-fundal varices, cannot be effectively treated by band ligation technically. 7 In addition, EVL could be used to control GV bleeding only from GOV1, EV extending below gastric cardia along lesser curvature. Basically, EVL should be performed on small GV, because it is difficult to suction both mucosal and contralateral wall of the vessel into ligator due to its large diameter and thick vessel wall. 6 Those endoscopic approaches, however, is quite limited to apply for GV bleeding. Traditionally, it has been reported that endoscopic therapy such as endoscopic variceal ligation (EVL) or endoscopic variceal obturation (EVO) have important roles in treating GV bleeding. 1, 2 GV bleeding is more severe (as reflected in transfusion requirement) than esophageal varices (EV) bleeding with higher mortality rates of up to 45% and 35% to 90% of patients were reported to rebleed after spontaneous hemostasis. Gastric varices (GV) are one of the most common complications of liver cirrhosis, occurring in approximately 20% of the patients.
0 Comments
Leave a Reply. |