Endoscopic treatment of bleeding gastric varices is considered a vital procedure aimed at stopping bleeding and minimizing its consequences. Gastric varices can be injected with specific substances to prevent bleeding. Gastric and esophageal varices develop due to portal hypertension, and they may not show any symptoms until they rupture, causing bleeding. Therefore, early detection and prompt intervention are crucial to prevent serious complications. When symptoms of gastric varices appear, immediate treatment is necessary. The treatment of gastric varices involves injecting them using an endoscope, imaging the affected area, and identifying points for injection to stop bleeding. Learn about the symptoms, treatment, and steps of Endoscopic treatment of bleeding gastric varices.
What are Gastric Varices?
Gastric varices are the dilation of blood vessels in the stomach. Although they may not produce symptoms when swollen, they can cause life-threatening internal bleeding if they rupture.
Gastric varices typically form when blood flow to the liver is obstructed, either through scar tissues or blood clots. As blood cannot flow through these main vessels, it turns into enlarged vessels. If left untreated, these vessels can eventually burst under pressure.
Fifty percent of patients with liver cirrhosis develop gastric varices, as well as 20% of patients with portal hypertension.
What Causes Gastric Varices?
In normal circumstances, blood flows from the intestines and spleen to the liver through the portal vein. However, when there is an obstruction to blood flow due to liver cirrhosis or portal hypertension, blood seeks alternative routes through the small vessels in the stomach or esophagus, leading to the formation of gastric varices. Gastric varices can occur for several reasons, including:
Liver cirrhosis, a major cause of gastric varices formation, as cirrhosis disrupts blood flow in the liver.
Portal hypertension resulting from factors like liver cirrhosis, which puts pressure on the blood, forcing it to find alternative paths outside the liver.
Blood clots in the splenic vein are another factor contributing to the formation of gastric varices.
These small vessels, unsuitable for accommodating large blood flow, cause swelling and dilation, making them more prone to rupture and internal bleeding.
What are the Symptoms of gastric Varices?
If gastric varices remain intact, patients will not experience any symptoms. However, if they bleed due to rupture, symptoms will begin to appear. The symptoms of gastric varices include:
- Coughing with blood-mixed phlegm.
- Vomiting resembling coffee grounds or vomit mixed with blood.
- Change in stool color to black.
- Increased heart rate.
- Dizziness.
- Fainting and shock in severe cases.
- These symptoms indicate the need for immediate treatment to prevent worsening of the condition.
What is the Treatment for Gastric Varices?
The treatment for gastric varices can be divided into two main categories:
1- Treatment for Bleeding Varices
Bleeding from gastric varices is considered a medical emergency, and it can be controlled using beta-blockers and ligation techniques. Endoscopic ligation is used to restrict the bleeding of varices, and in some cases, antibiotics are recommended to prevent recurrent bleeding or additional complications.
2- Endoscopic Treatment for Variceal Bleeding
Endoscopic injection of bleeding gastric varices is the most commonly used procedure to deal with immediate bleeding in the esophagus and stomach. Endoscopic treatment is also used to prevent recurrent bleeding of varices.
Endoscopic treatment methods include:
- Endoscopic Variceal Ligation: Flexible rings are placed around the varices to restrict blood flow and prevent bleeding.
- Endoscopic injection treatment of bleeding gastric varices: Chemicals are injected directly into the dilated vein or into the stomach wall near the dilated veins. This causes inflammation of the inner lining of the vein, and over time, the vein becomes blocked, forming a scar, preventing blood flow.
- Endoscopic treatment is usually accompanied by medications such as beta-blockers and vasoconstrictors to achieve better results in treating gastric varices.
Endoscopic Variceal Ligation
During the endoscopic ligation procedure, the doctor uses an endoscopic device to place a flexible ring resembling a rubber band around the swollen vein, known as varices. This ligation cuts off blood flow through the dilated vein, contributing to controlling the condition.
Endoscopic variceal ligation is effective, especially in treating cases of variceal bleeding, and it shows fewer complications compared to some other methods such as sclerotherapy. Performing this procedure may be challenging during active bleeding cases because it can obstruct the doctor’s view.
The process of variceal ligation is performed several times to ensure control of the condition and prevent future bleeding. The ligation is repeated every 2 to 4 weeks, and the sessions are repeated for a duration ranging from 3 to 4 times. Afterward, the doctor monitors the varices every 3 to 12 months to ensure sustainable results.
Endoscopic injection treatment of bleeding gastric varices
During the treatment of stomach endoscopy for the injection of bleeding gastric varices, a chemical called “sclerosant” can be injected directly into the dilated vein or into the stomach wall near the dilated veins.
This substance leads to inflammation of the inner lining of the vein, and as time passes, the vein becomes blocked, forming a blood clot, preventing blood flow. Treatment with stomach endoscopy for the injection of bleeding gastric varices can be effective in stopping immediate bleeding, and although this treatment is performed in emergency cases, it is not as common as it was in the past.
Currently, doctors frequently use variceal band ligation to treat and prevent bleeding from varices. If treatment is performed using Endoscopic treatment of bleeding gastric varices, ligation of the varices is often performed later to prevent future bleeding.
Other Treatments for Gastric Varices
In addition to Endoscopic treatment of bleeding gastric varices by Endoscopic injection and endoscopic ligation of gastric varices, the doctor may choose advanced procedures, including:
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): This procedure involves diverting the blood flow away from the portal vein. This can be done surgically or by inserting a catheter through the jugular vein or neck vein.
- Liver Transplantation: In cases where control or recurrence of bleeding is not achieved, some patients may require liver transplantation or spleen removal.
These procedures are considered the last and advanced options in treating severe and life-threatening cases of gastric variceal bleeding. The decision to use these procedures is based on a comprehensive assessment of the patient’s health condition and medical history.
Where Can I Undergo Stomach Endoscopy for the Injection of Bleeding Gastric Varices?
Dr. Mohamed Al Boraie is considered the best doctor to perform Endoscopic treatment of bleeding gastric varices and endoscopic ligation of gastric varices. He is a consultant in hepatology, gastroenterology, and endoscopy, a Fellow of the Royal College of Physicians in England, and a member of the American College of Gastroenterology. Dr. Mohamed Al Boraie currently works as a lecturer in general internal medicine, hepatology, and gastroenterology at Al-Azhar University Faculty of Medicine in Cairo. He actively participates in various local and international scientific conferences and has numerous scientific research publications in prestigious medical journals.
Book your appointment now if you would like to consult with Dr. Mohamed Al Boraie regarding the diagnosis and treatment of gastric varices using the latest endoscopic methods.