Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy|Continue
JAMA Surgery
Sign In
Individual Sign In
Sign inCreate an Account
Access through your institution
Sign In
This Issue
Review
April 3, 2019
Edward WolfgangLee,MD, PhD1,2; PujaShahrouki,MD1; LourdesAlanis,MD, MPH1; et al PengxuDing,MD1; Stephen T.Kee,MD1
Author Affiliations Article Information
-
1Division of Interventional Radiology, Department of Radiology, University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California, Los Angeles
-
2Division of Liver and Pancreas Transplantation, Department of Surgery, University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California, Los Angeles
JAMA Surg. 2019;154(6):540-548. doi:10.1001/jamasurg.2019.0407
Full Text
Abstract
Importance Varices are one of the main clinical manifestations of cirrhosis and portal hypertension. Gastric varices are less common than esophageal varices but are often associated with poorer prognosis, mainly because of their higher propensity to bleed.
Observations Currently, treatments used to control and manage gastric variceal bleeding include β-blockers, endoscopic injection sclerotherapy, endoscopic variceal ligation, endoscopic variceal obturation, shunt surgery, transjugular intrahepatic portosystemic shunts, balloon-occluded retrograde transvenous obliteration (BRTO), and modified BRTO. In the past few decades, Western (United States and Europe) interventional radiologists have preferred transjugular intrahepatic portosystemic shunts that aim to decompress the liver and reduce portal pressure. Conversely, Eastern radiologists (Japan and South Korea) have preferred BRTO that directly targets the gastric varices. Over the past 20 years, BRTO has evolved and procedure-related risks have decreased. Owing to its safety and efficiency in treating gastric varices, BRTO is now starting to gain popularity among Western interventional radiologists. In this review, we present a comprehensive literature review of current and emerging management options, including BRTO and modified BRTO, for the treatment of gastric varices in the setting of cirrhosis and portal hypertension.
Conclusions and Relevance Balloon-occluded retrograde transvenous obliteration has emerged as a safe and effective alternative treatment option for gastric variceal hemorrhage. A proper training, evidence-based consensus and guideline, thorough preprocedural and postprocedural evaluation, and a multidisciplinary team approach with BRTO and modified BRTO are strongly recommended to ensure best patient care.
Full Text
Add or change institution
Comment
Read More About
Bleeding and Transfusion Hepatobiliary Disease Gastroenterology and Hepatology
Citation
Lee EW, Shahrouki P, Alanis L, Ding P, Kee ST. Management Options for Gastric Variceal Hemorrhage. JAMA Surg. 2019;154(6):540–548. doi:10.1001/jamasurg.2019.0407
Manage citations:
Ris (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley
© 2024
Comment
Add or change institution
Artificial Intelligence ResourceCenter
Others Also Liked
Select Your Interests
Customize your JAMA Network experience by selecting one or more topics from the list below.
- Academic Medicine
- Acid Base, Electrolytes, Fluids
- Allergy and Clinical Immunology
- American Indian or Alaska Natives
- Anesthesiology
- Anticoagulation
- Art and Images in Psychiatry
- Artificial Intelligence
- Assisted Reproduction
- Bleeding and Transfusion
- Cardiology
- Caring for the Critically Ill Patient
- Challenges in Clinical Electrocardiography
- Climate and Health
- Climate Change
- Clinical Challenge
- Clinical Decision Support
- Clinical Implications of Basic Neuroscience
- Clinical Pharmacy and Pharmacology
- Complementary and Alternative Medicine
- Consensus Statements
- Coronavirus (COVID-19)
- Critical Care Medicine
- Cultural Competency
- Dental Medicine
- Dermatology
- Diabetes and Endocrinology
- Diagnostic Test Interpretation
- Drug Development
- Electronic Health Records
- Emergency Medicine
- End of Life, Hospice, Palliative Care
- Environmental Health
- Equity, Diversity, and Inclusion
- Ethics
- Facial Plastic Surgery
- Gastroenterology and Hepatology
- Genetics and Genomics
- Genomics and Precision Health
- Geriatrics
- Global Health
- Guide to Statistics and Methods
- Guidelines
- Hair Disorders
- Health Care Delivery Models
- Health Care Economics, Insurance, Payment
- Health Care Quality
- Health Care Reform
- Health Care Safety
- Health Care Workforce
- Health Disparities
- Health Inequities
- Health Policy
- Health Systems Science
- Hematology
- History of Medicine
- Humanities
- Hypertension
- Images in Neurology
- Implementation Science
- Infectious Diseases
- Innovations in Health Care Delivery
- JAMA Infographic
- Law and Medicine
- Leading Change
- Less is More
- LGBTQIA Medicine
- Lifestyle Behaviors
- Medical Coding
- Medical Devices and Equipment
- Medical Education
- Medical Education and Training
- Medical Journals and Publishing
- Melanoma
- Mobile Health and Telemedicine
- Narrative Medicine
- Nephrology
- Neurology
- Neuroscience and Psychiatry
- Notable Notes
- Nursing
- Nutrition
- Nutrition, Obesity, Exercise
- Obesity
- Obstetrics and Gynecology
- Occupational Health
- Oncology
- Ophthalmology
- Orthopedics
- Otolaryngology
- Pain Medicine
- Palliative Care
- Pathology and Laboratory Medicine
- Patient Care
- Patient Information
- Pediatrics
- Performance Improvement
- Performance Measures
- Perioperative Care and Consultation
- Pharmacoeconomics
- Pharmacoepidemiology
- Pharmacogenetics
- Pharmacy and Clinical Pharmacology
- Physical Medicine and Rehabilitation
- Physical Therapy
- Physician Leadership
- Poetry
- Population Health
- Primary Care
- Professional Well-being
- Professionalism
- Psychiatry and Behavioral Health
- Public Health
- Pulmonary Medicine
- Radiology
- Regulatory Agencies
- Reproductive Health
- Research, Methods, Statistics
- Resuscitation
- Rheumatology
- Risk Management
- Scientific Discovery and the Future of Medicine
- Shared Decision Making and Communication
- Sleep Medicine
- Sports Medicine
- Stem Cell Transplantation
- Substance Use and Addiction Medicine
- Surgery
- Surgical Innovation
- Surgical Pearls
- Teachable Moment
- Technology and Finance
- The Art of JAMA
- The Arts and Medicine
- The Rational Clinical Examination
- Tobacco and e-Cigarettes
- Toxicology
- Translational Medicine
- Trauma and Injury
- Treatment Adherence
- Ultrasonography
- Urology
- Users' Guide to the Medical Literature
- Vaccination
- Venous Thromboembolism
- Veterans Health
- Violence
- Women's Health
- Workflow and Process
- Wound Care, Infection, Healing
Save Preferences
Privacy Policy | Terms of Use
X
.
Access your subscriptions
Add or change institution
Free access to newly published articles
To register for email alerts, access free PDF, and more
Purchase access
Get full journal access for 1 year
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Rent this article from DeepDyve
Access your subscriptions
Add or change institution
Free access to newly published articles
To register for email alerts, access free PDF, and more
Purchase access
Get full journal access for 1 year
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Rent this article from DeepDyve
Sign in to access free PDF
Add or change institution
Free access to newly published articles
To register for email alerts, access free PDF, and more
Save your search
Free access to newly published articles
To register for email alerts, access free PDF, and more
Purchase access
Customize your interests
Free access to newly published articles
To register for email alerts, access free PDF, and more
Create a personal account or sign in to:
- Register for email alerts with links to free full-text articles
- Access PDFs of free articles
- Manage your interests
- Save searches and receive search alerts
Privacy Policy
Make a comment
Free access to newly published articles
To register for email alerts, access free PDF, and more
Create a personal account or sign in to:
- Register for email alerts with links to free full-text articles
- Access PDFs of free articles
- Manage your interests
- Save searches and receive search alerts
Privacy Policy
