Gastric Varices, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Massive Upper Gastrointestinal , In this video clip, you can observe one of the worst bleeding.of the gastrointestinal track. It is more difficult to stop bleeding from the gastric varices than from the esophageal varices. The rate of hemostasis by endoscopic management is higher with the Histoacryl than that with the other sclerosing agents such as 5% ethanolamine oleate. After introducing N-butyl-2-cyanoacrylate (Histoacryl) to the management of bleeding gastric varices, the hemostasis rate improves to almost 100% However, the rebleeding rate is still high if any further additional treatment has not been performed until the gastric varices have been eradicated. There is still a controversy regarding the management for the gastric varices.

Video Endoscopic Sequence 1 of 3.

Massive Upper Gastrointestinal Bleeding.

 In this video clip, you can observe one of the worst
 bleeding of the gastrointestinal track.

 It is more difficult to stop bleeding from the gastric varices
 than from the esophageal varices. The rate of hemostasis
 by endoscopic management is higher with the Histoacryl
 than that with the other sclerosing agents such as 5%
 ethanolamine oleate.

 After introducing N-butyl-2 -cyanoacrylate (Histoacryl) to
 the management of bleeding gastric varices, the hemostasis
 rate improves to almost 100% However, the rebleeding
 rate is still high if any further additional treatment has not
 been performed until the gastric varices have been
 eradicated. There is still a controversy regarding the
 management for the gastric varices.

 For more endoscopic details, download the video clips
 by clicking on the endoscopic images. Wait to be
 downloaded complete then Press Alt and Enter for full
 screen.
 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode.                                                                                Medline.
Bleeding from gastric varices is a life-threatening complication of portal hypertension. Fundal and isolated gastric varices are at high risk for variceal bleeding

Video Endoscopic Sequence 2 of 3.

 Bleeding from gastric varices is a life-threatening
 complication of portal  hypertension. Fundal and isolated
 gastric varices are at high risk for variceal bleeding.

 
Argon Plasma Coagulation was used as emergency tool. Gastric varices occur in about 20% of patients with portal hypertension and approxiamately 25% of gastric varices bleed during lifetime. Gastric variceal bleeding has a higher rate of recurrence than esophageal variceal bleeding, and is associated with decreased survival. The cumulative mortality of fundal varices reaches as high as 52% at the end of 1 year.

Video Endoscopic Sequence 3 of 3.

Argon Plasma Coagulation was used as a emergency tool.

 Gastric varices occur in about 20% of patients with portal
 hypertension and approxiamately 25% of gastric varices
 bleed during lifetime. Gastric variceal bleeding has a
 higher rate of recurrence than esophageal variceal
 bleeding, and is associated with decreased survival. The
 cumulative mortality of fundal varices reaches as high as
 52% at the end of 1 year.
This 66 year old female, presented with massive upper gastrointestinal bleeding. Endoscopy revealed spurting from a large varix in the gastric fundus.

Video Endoscopic Sequence 1 of 7.

 This 66 year old female, presented with massive upper
 gastrointestinal bleeding. Endoscopy revealed spurting
 from a large varix in the gastric fundus.

 Bleeding from gastric varices is a life-threatening event
 that presents a therapeutic challenge for clinicians.

 
Active pulsatile bleeding from a gastric fundic, varix was seen at endoscopy. Gastric Varices are much less common cause of variceal hemorrhage than Esophageal ones; but are important to recognize as the source of bleeding because their management is different. When gastric varices are prominent and associated with minimal to absent Esophageal varices, one must consider splecnic vein thrombosis as the etiology of the increased venous pressures. Angiography may verify this diagnosis. These patients are best treated with simple splecnectomy, which adequately decompresses their varices. Such patients have an excellent prognosis because of the lack of underlying liver disease. Splecnic vein thrombosis may occur as a complication of pancreatitis due to contiguous inflammation from the body and tail of the pancreas. Histoacryl (N-butyl-2-cyanocrylate) has been used in bleeding esophagus gastric and ectopic varices.

Video Endoscopic Sequence 2 of 7.

 Active pulsatile bleeding from a gastric fundic, varix was
 seen at endoscopy.

 Gastric Varices are much less common cause of variceal
 hemorrhage than esophageal ones; but are important to
 recognize as the source of bleeding because their
 management is different. When gastric varices are
 prominent and associated with minimal to absent
 esophageal varices, one must consider splecnic vein
 thrombosis as the etiology of the increased venous
 pressures. Angiography may verify this diagnosis. These
 patients are best treated with simple splecnectomy, which
 adequately decompresses their varices.
 Such patients have an excellent prognosis because of the
 lack of underlying liver disease.
 Splecnic vein thrombosis may occur as a complication of
 pancreatitis due to contiguous inflammation from the body
 and tail of the pancreas. 
 Histoacryl (N-butyl-2-cyanocrylate) has been used in
 bleeding esophagogastric and ectopic varices.
 

                                           Medline.
Continuous flow of blood from the varix. Gastric varices occur in about 20% of patients with portal. Hypertension and approximately 25% of gastric varices bleed during lifetime. Gastric variceal bleeding especially from isolated gastric varices usually is profuse, has a higher rate of recurrence than Esophageal variceal bleeding , and is associated with decreased survival (cumulative mortality of fundal varices reaching as high as 52% at the end of 1 year). The optimal treatment for gastric variceal bleeding is still controversial, primarily because of the apparent ineffectiveness of conventional antivariceal therapy and the inclusion of patients with gastric varices located at different sites.

Video Endoscopic Sequence 3 of 7.

Continuous flow of blood from the varix.

 Gastric varices occur in about 20% of patients with portal
 hypertension and approximately 25% of gastric varices
 bleed during lifetime. Gastric variceal bleeding especially
 from isolated gastric varices usually is profuse, has a
 higher rate of recurrence than esophageal variceal bleeding
 , and is associated with decreased survival (cumulative
 mortality of fundal varices reaching as high as 52% at the
 end of 1 year). The optimal treatment for gastric variceal
 bleeding is still controversial, primarily because of the
 apparent ineffectiveness of conventional antivariceal
 therapy and the inclusion of patients with gastric varices
 located at different sites.
Hemostasis was achieved using argon plasma coagulator APC. Bleeding from gastric varices is often a serious medical emergency. Although the incidence of bleeding from gastric varices is relatively low (10?36%), massive bleeding from gastric varices is life-threatening.

Video Endoscopic Sequence 4 of 7.

 Hemostasis was achieved using argon plasma coagulator
 APC.

 Bleeding from gastric varices is often a serious medical
 emergency.

 Although the incidence of bleeding from gastric varices is
 relatively low (10–36%), massive bleeding from gastric
 varices is life-threatening.

 
The video clip displays the APC stopping the hemorrhage. Endoscopic variceal ligation is safer and more efficacious than sclerotherapy as initial treatment of bleeding esophageal varices, whereas cyanoacrylate injection is the endoscopic treatment of choice for gastric varices. An adjuvant vasoactive agent is useful for the prevention of early rebleeding. Follow-up endoscopic treatment is necessary in order to obliterate residual varices.

Video Endoscopic Sequence 5 of 7.

 The video clip displays the APC stopping the hemorrhage.

 Endoscopic variceal ligation is safer and more efficacious
 than sclerotherapy as initial treatment of bleeding
 esophageal varices, whereas cyanoacrylate injection is the
 endoscopic treatment of choice for gastric varices. An
 adjuvant vasoactive agent is useful for the prevention of
 early rebleeding.

 Follow-up endoscopic treatment is necessary in order to
 obliterate residual varices.

Status post coagulation with APC.

Video Endoscopic Sequence 6 of 7.

Status post coagulation with APC.

 
Status post APC application seen with magnifying endoscope. Endoscopic ultrasonography is useful in the prediction of recurrence of varices and facilitates visualization and guidance of further treatment of gastric varices.

Video Endoscopic Sequence 7 of 7.

 Status post APC application seen with magnifying
 endoscope.

 Endoscopic ultrasonography is useful in the prediction of
 recurrence of varices and facilitates visualization and
 guidance of further treatment of gastric varices.





                                          Medline.

Video Endoscopic Sequence 1 of 5.

Large Gastric Varices.

This 56 year-old lady with esophagus-Gastric Varices.
Development of gastric varices is an important manifestation of portal hypertension. In segmental portal hypertension, gastric varices originate from short gastric and gastroepiploic veins. In generalized portal hypertension, intrinsic veins at cardia participate in the formation of gastric varices. Endoscopy and/or splenoportovenography and a high index of suspicion are required for the diagnosis of gastric varices.

Video Endoscopic Sequence 2 of 5.

 Development of gastric varices is an important
 manifestation of portal hypertension. In segmental portal
 hypertension, gastric varices originate from short gastric
 and gastroepiploic veins. In generalized portal
 hypertension, intrinsic veins at cardia participate in the
 formation of gastric varices. Endoscopy and/or
 splenoportovenography and a high index of suspicion are
 required for the diagnosis of gastric varices.

 
TeteVar3

Video Endoscopic Sequence 3 of 5.

Sarin’s classification of gastric varices

Figure 1

Image1VG

Sarin et al. defined four subtypes of gastric varices (Figure 1). Gastro-oesophageal varices (GOVs) are associated with oesophageal varices along the lesser curve (type 1, GOV1), or along the fundus (type 2, GOV2). Isolated gastric varices (IGVs) are present in isolation in the fundus (IGV1) or at ectopic sites in the stomach or the first part of the duodenum (IGV2). Gastric varices may be primary (at initial presentation) or secondary (appearing after obliteration of oesophageal varices). GOV1, the commonest at 70% of gastric varices, are also known as cardial varices. GOV2 and IGV1, at 21% and 7% of gastric varices, respectively, together referred to as fundal varices. The incidence of bleeding is highest with IGV1 (78%), followed by GOV2 (55%), and much less for GOV1 and IGV2 at 10%. Although the mortality rate with GOV1 is high, endoscopic treatment of GOV1 is likely to be more successful than the other subtypes.

Video Endoscopic Sequence 4 of 5.

Sarin et al. defined four subtypes of gastric varices (Figure 1). Gastro-oesophageal varices (GOVs) are associated with oesophageal varices along the lesser curve (type 1, GOV1), or along the fundus (type 2, GOV2). Isolated gastric varices (IGVs) are present in isolation in the fundus (IGV1) or at ectopic sites in the stomach or the first part of the duodenum (IGV2). Gastric varices may be primary (at initial presentation) or secondary (appearing after obliteration of oesophageal varices). GOV1, the commonest at 70% of gastric varices, are also known as cardial varices. GOV2 and IGV1, at 21% and 7% of gastric varices, respectively, together referred to as fundal varices. The incidence of bleeding is highest with IGV1 (78%), followed by GOV2 (55%), and much less for GOV1 and IGV2 at 10%. Although the mortality rate with GOV1 is high, endoscopic treatment of GOV1 is likely to be more successful than the other subtypes.

 
The natural history of bleeding gastric varices differs from that of esophageal varices. Although the risk of bleeding from gastric varices is half that of oesophageal varices, the transfusion requirements and mortality once bleeding has occurred are greater particularly for IGV. It has been reported that patients with large gastric varices have a lower portal pressure than those with oesophageal varices, which may be as a result of the development of gastrorenal porto-systemic shunts, or large size of the varices resulting in increased variceal wall tension.

Video Endoscopic Sequence 5 of 5.

The natural history of bleeding gastric varices differs from that of esophageal varices. Although the risk of bleeding from gastric varices is half that of oesophageal varices, the transfusion requirements and mortality once bleeding has occurred are greater particularly for IGV. It has been reported that patients with large gastric varices have a lower portal pressure than those with oesophageal varices, which may be as a result of the development of gastrorenal porto-systemic shunts, or large size of the varices resulting in increased variceal wall tension.

 
Endoscopic ablation with cyanoacrylate glue This 49 year-old female was hospitalized in a social security hospital in El Salvador, She was discharged from the hospital on day 10, after that visit us for a therapeutical endoscopy. An upper endoscopy was practiced shows gastric varices of the fundus with a small quantity of blood emerging from the varix.

Video Endoscopic Sequence 1 of 16.

Endoscopic Ablation with Cyanoacrylate Glue

 This 49 year-old female was hospitalized in a social security
 hospital in El Salvador, She was discharged from the
 hospital on day 10, after that visit us for a therapeutical
 endoscopy.

 An upper endoscopy was practiced shows gastric varices of
 the fundus with a small quantity of blood emerging from the
 varix.
Although gastric varices tend to bleed less frequently than esophageal varices, the morbidity and mortality associated with gastric variceal hemorrhage are substantial.

Video Endoscopic Sequence 2 of 16..

 Although gastric varices tend to bleed less frequently than
 esophageal varices, the morbidity and mortality associated
 with gastric variceal hemorrhage are substantial.

 Gastric varices are dilated submucosal veins in the
 stomach, which can be a life-threatening cause of upper
 gastrointestinal hemorrhage. They are most commonly
 found in patients with portal hypertension, or elevated
 pressure in the portal vein system, which may be a
 complication of cirrhosis. Gastric varices may also be
 found in patients with thrombosis of the splenic vein, into
 which the short gastric veins which drain the fundus of the
 stomach flow. The latter may be a complication of acute
 pancreatitis, pancreatic cancer, or other abdominal
 tumours.
In the same day a therapeutic endoscopy a histoacryl injection is programed, under general anesthesia with endotracheal tube is achieved. Stigmata of recent bleeding.

Video Endoscopic Sequence 3 of 16.

 In the same day a therapeutic endoscopy a histoacryl
 injection is programed, under general anesthesia with
 endotracheal tube is achieved. Stigmata of recent bleeding
 is observed.

 
More images and video clips.

Video Endoscopic Sequence 4 of 16.

More images and video clips.
N-butyl-2-cyanoacrylate (Histoacryl) is a watery substance that polymerizes and hardens instantaneously when it comes into contact with blood. This unique property makes it attractive for use in obliterating varices. It is particularly useful in the treatment of fundic varices. Histoacryl is reconstituted with Lipiodol (0.8 mL in 0.5 mL), an oil-based radiopaque contrast agent . ). the therapeutic channel of the endoscope is first rinsed with 2mL of Lipiodol. The injection needle is then filled with 2mL of Lipiodol. The varix is punctured, and the Histoacryl-Lipiodol mixture is injected. Before retraction of the needle, residual glue is pushed into the varix with a further 2mL of Lipiodol. The needle is then retracted, and the catheter is rinsed with water. It is important at this juncture not to activate suction in the endoscope, and to continue irrigation to avoid contact between the glue and the lenses .

Video Endoscopic Sequence 5 of 16.

 N-butyl-2-cyanoacrylate (Histoacryl) is a watery substance
 that polymerizes and hardens instantaneously when it
 comes into contact with blood. This unique property makes
 it attractive for use in obliterating varices. It is particularly
 useful in the treatment of fundic varices. Histoacryl is
 reconstituted with Lipiodol (0.8 mL in 0.5 mL), an oil-based
 radiopaque contrast agent). the therapeutic channel of the
 endoscope is first rinsed with 2mL of Lipiodol.
 The injection needle is then filled with 2mL of Lipiodol.
 The varix is punctured, and the Histoacryl-Lipiodol mixture
 is injected. Before retraction of the needle, residual glue is
 pushed into the varix with a further 2mL of Lipiodol. The
 needle is then retracted, and the catheter is rinsed with
 water. It is important at this juncture not to activate suction
 in the endoscope, and to continue irrigation to avoid
 contact between the glue and the lenses. 

The image and the video clip show the status of histoacryl injection. When Histoacryl is mixed in a ratio of 0.5 cm3 (volume per tube of Histoacryl) to 0.8 cm' Lipiodol, hardening is delayed by approximately 20 seconds. The two components are drawn up together into a 2 ml syringe and then mixed by inverting the syringe several times. To help prevent Histoacryl from adhering to the catheter wall, several millilitres of Lipiodol are injected into the catheter.

Video Endoscopic Sequence 6 of 16..

The image and the video clip show the status of histoacryl injection.

 When Histoacryl is mixed in a ratio of 0.5 cm3 (volume per
 tube of Histoacryl) to 0.8 cm' Lipiodol, hardening is
 delayed by approximately 20 seconds. The two components
 are drawn up together into a 2 ml syringe and then mixed
 by inverting the syringe several times. To help prevent
 Histoacryl from adhering to the catheter wall, several
 millilitres of Lipiodol are injected into the catheter.
The image and the video clips show the second shot of histoacryl.

Video Endoscopic Sequence 7 of 16.

The image and the video clips show the second shot of histoacryl.
he image and the video clips show the third shot of histoacryl.

Video Endoscopic Sequence 8 of 16.

The image and the video clips show the third shot of histoacryl.

 
Hemostatic methods that use standard therapy for esophageal varices have not been found effective for gastric varices. Due to their large size and extensive distribution, it is difficult if not impossible to eradicate gastric varices with sclerotherapy or band ligation. More importantly, tissue necrosis resulting from these endoscopic interventions can cause significant and sometimes disastrous complications.

Video Endoscopic Sequence 9 of 16.

 Hemostatic methods that use standard therapy for
 esophageal varices have not been found effective for
 gastric varices. Due to their large size and extensive
 distribution, it is difficult if not impossible to eradicate
 gastric varices with sclerotherapy or band ligation. More
 importantly, tissue necrosis resulting from these
 endoscopic interventions can cause significant and
 sometimes disastrous complications.
Conceptually, cyanoacrylate glue provides an ideal endoscopic treatment for gastric varices. Native cyanoacrylate is a liquid with a consistency similar to water and therefore lends itself to intravariceal injection. When added to a physiologic medium such as blood, the cyanoacrylate rapidly polymerizes, forming a hard substance. Thus, after injection into a varix, the cyanoacrylate plugs the lumen. This results not only in rapid hemostasis in cases of active bleeding, but it also prevents the recurrence of bleeding from the treated varix.

Video Endoscopic Sequence 10 of 16.

 Conceptually, cyanoacrylate glue provides an ideal
 endoscopic treatment for gastric varices. Native
 cyanoacrylate is a liquid with a consistency similar to water
 and therefore lends itself to intravariceal injection. When
 added to a physiologic medium such as blood, the
 cyanoacrylate rapidly polymerizes, forming a hard
 substance. Thus, after injection into a varix, the
 cyanoacrylate plugs the lumen. This results not only in
 rapid hemostasis in cases of active bleeding, but it also
 prevents the recurrence of bleeding from the treated varix.
Histoacryl is highly effective for the treatment of bleeding gastric varices. The treatment failure-related mortality rate was almost a result of malignancy or underlying liver disease. Serious adverse event may appear although under experienced endoscopist.

Video Endoscopic Sequence 11 of 16.

 Histoacryl is highly effective for the treatment of bleeding
 gastric varices. The treatment failure-related mortality rate
 was almost a result of malignancy or underlying liver
 disease. Serious adverse event may appear although under
 experienced endoscopist.

 
A follow up endoscopy one week later was performed. Status post injection of histoacryl mixture.

Video Endoscopic Sequence 12 of 16.

A follow up endoscopy one week later was performed.

Status post injection of histoacryl mixture.
Cyanoacrylate12

Video Endoscopic Sequence 13 of 16.

More images and video clips.
Massive transfusions by nature lead to hemodilution, acidosis, hypothermia and ultimately coagulopathy. To minimize these complications it is recommended to replace plasma constituents and platelets with packed red blood cell infusions. A protocol with a replacement ratio of 5 PRBC, 5 FFP and 2 units of platelets minimizes bleeding, hemodilution and persistent thrombocytopenia.

Video Endoscopic Sequence 14 of 16.

 Massive transfusions by nature lead to hemodilution,
 acidosis, hypothermia and ultimately coagulopathy. To
 minimize these complications it is recommended to replace
 plasma constituents and platelets with packed red blood
 cell infusions. A protocol with a replacement ratio of 5
 PRBC, 5 FFP and 2 units of platelets minimizes bleeding,
 hemodilution and persistent thrombocytopenia.

 
Status post variceal ligation is observed at the cardias.

Video Endoscopic Sequence 15 of 16.

Status post variceal ligation is observed at the cardias.
Fibrin and ulcers of post banding at the esophagus are displayed.

Video Endoscopic Sequence 16 of 16.

Fibrin and ulcers of post banding at the esophagus are displayed

Large Gastric Varices. This 72 year old female with a recurrent episode of bleeding from gastric varices. Seen on retroflexion are pendulous varices in the gastric cardia and fundus.

Video Endoscopic Sequence 1 of 4.

Large Gastric Varices.

 This 72 year old female with a recurrent episode of
 bleeding from gastric varices. Seen on retroflexion are
 pendulous varices in the gastric cardia and fundus.

 
Ulcerated Gastric Varix. Primary gastric varices are said to be detected in 20% patients with portal hypertensions. The data suggests that gastric varices bleed less frequently (14%-16%) , but once it bleeds it is torrential and severe.

Video Endoscopic Sequence 2 of 4.

Ulcerated Gastric Varix.

 Primary gastric varices are said to be detected in 20%
 patients with portal hypertensions. The data suggests that
 gastric varices bleed less frequently (14%-16%) , but
 once it bleeds it is torrential and severe.

 
The patient underwent Cyanoacrylate glue injection for her gastric varices. Variceal obstruction with cyanoacrylate tissue adhesive had been used successfully and most studies have achieved control of bleeding in almost 100% of patients.

Video Endoscopic Sequence 3 of 4.

 The patient underwent Cyanoacrylate glue injection for her
 gastricvarices.

 Variceal obstruction with cyanoacrylate tissue adhesive had been
 used successfully and most studies have achieved control of
 bleeding in almost 100% of patients.

 
This image and the video clip was obtained with magnifying endoscope. Gastric varices develop in patients with portal hypertension, including liver cirrhosis, idiopathic portal hypertension as well as left sided-local portal hypertension such as splenic vein thrombosis or splenic AV malformation. The inflow vein is the left gastric vein, posterior vein, or short gastric vein, while the outflow vein is the gastro-renal shunt in most of the patients with gastric varices. The form of the gastric varices is classified into three types of venous dilatation; tortuous type, notched type and tumor type according to the shape and size of the varices.

Video Endoscopic Sequence 4 of 4.

 This image and the video clip was obtained with magnifying
 endoscope.

 Gastric varices develop in patients with portal hypertension
 , including liver cirrhosis, idiopathic portal hypertension as
 well as left sided-local portal hypertension such as splenic
 vein thrombosis or splenic AV malformation. The inflow
 vein is the left gastric vein, posterior vein, or short gastric
 vein, while the outflow vein is the gastro-renal shunt in
 most of the patients with gastric varices. The form of the
 gastric varices is classified into three types of venous
 dilatation; tortuous type, notched type and tumor type
 according to the shape and size of the varices.

 
Fundus Varices. Fundus varices are observed in the maneuver of retroflexion, and the signs of recent bleeding are also observed. Gastric varices usually accompany esophageal varices, although they may occur alone. They are located in the gastric fundus and are best appreciated endoscopically on retroflexed view.

 Fundus Varices.

 Fundus varices are observed in the maneuver of
 retroflexion, and the signs of recent bleeding are also
 observed.


 Gastric varices usually accompany esophageal varices,
 although they may occur alone. They are located in the
 gastric fundus and are best appreciated endoscopically on
 retroflexed view. 
Gastric Varix of the fundus that caused severe gastrointestinal hemorrhage. Gastric Varices are much less common cause of variceal hemorrhage than esophageal ones; but are important to recognize as the source of bleeding because their management is different. When gastric varices are prominent and associated with minimal to absent esophageal varices, one must consider splecnic vein thrombosis as the etiology of the increased venous pressures. Angiography may verify this diagnosis. These patients are best treated with simple splecnectomy, which adequately decompresses their varices. Such patients have an excellent prognosis because of the lack of underlying liver disease. Splecnic vein thrombosis may occur as a complication of pancreatitis due to contiguous inflammation from the body and tail of the pancreas.Histoacryl (N-butyl-2-cyanocrylate) has been used in bleeding esophagogastric and ectopic varices.

Enormous Erosioned Gastric Varix.

 Gastric Varix of the fundus that caused severe
 gastrointestinal hemorrhage.

 
 
Varices of the gastric fundus. More commonly, bleeding gastric varices are associated with large esophageal varices and are due to underlying liver disease.

Varices of the Gastric Fundus.

 More commonly, bleeding gastric varices are associated
 with large esophageal varices and are due to underlying
 liver disease. 

A 90 year-old female with fundus varices recent bleeding activity is observed.

Fundus Varices.

 A 90 year-old female with fundus varices, recent bleeding
 activity is observed.
Status Post Histoacryl. Histoacryl was injected intravariceally. Histoacryl injection sclerotherapy is highly effective for the treatment of bleeding gastric varices, with rare complications occurring both acutely and long-term. Therefore, Histoacryl injection sclerotherapy is considered to be the first choice of treatment for bleeding gastric varices, but the rate of recurrent bleeding is so high that further methods or devices still need to be developed in order to prevent gastric variceal rebleeding.

 Status Post Histoacryl.

Histoacryl was injected intravariceally.

 Histoacryl injection sclerotherapy is highly effective for the
 treatment of bleeding gastric varices, with rare
 complications occurring both acutely and long-term.
 Therefore, Histoacryl injection sclerotherapy is considered
 to be the first choice of treatment for bleeding gastric
 varices, but the rate of recurrent bleeding is so high that
 further methods or devices still need to be developed in
 order to prevent gastric variceal rebleeding.