AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review

Clin Gastroenterol Hepatol. 2021 Jun;19(6):1098-1107.e1. doi: 10.1016/j.cgh.2021.01.027. Epub 2021 Jan 22.


Management of bleeding gastric varices (GV) presents a unique challenge for patients with portal hypertension. Despite over thirty years of diagnostic and treatment advances standardized practices for bleeding GV are lacking and unsupported by adequate evidence. There are no definitive natural history studies to help with risk assessment or prospective clinical trials to guide clinical decision making. Available literature on the natural history and management of gastric varices consists of case series, restricted cohort studies, and a few small randomized trials, all of which have significant selection biases. This review summarizes the available data and recommendations based on expert opinion on how best to diagnose and manage bleeding from gastric varices. Table 1 summarizes our recommendations.

Keywords: BRTO; Endoscopic Cyanoacrylate; Gastric Varices; Portal Hypertension; TIPS.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Balloon Occlusion*
  • Esophageal and Gastric Varices* / diagnosis
  • Esophageal and Gastric Varices* / therapy
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / therapy
  • Humans
  • Portasystemic Shunt, Transjugular Intrahepatic*
  • Prospective Studies
  • Treatment Outcome