VHJOE- Editor's Column: Gastric Varices

Editor's Column: Gastric Varices

John C. Deutsch , M.D. (St. Mary's Duluth Clinic)

VHJOE Editor:

John Deutsch, MD
St. Mary's Duluth Clinic

Editorial Board:

Manoop S. Bhutani, MD
University of Texas
Medical Branch

William R. Brugge, MD
Massachusetts General Hospital

Peter R. McNally, DO
Denver, CO

Thomas J. Savides, MD
University of California,
San Diego

C. Mel Wilcox, MD
University of Alabama, Birmingham

Figure 1

Figure 2: Click here
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Interactive Atlas

Video Clip 1: A case of isolated gastric varicies from splenic vein obstruction by tumor.

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Gastric varices can be a perplexing problem for gastroenterologists to manage. These vascular channels can be large and deep, and bleeding can be difficult to control (1).

In some incidences, gastric varices can be isolated and due to splenic vein thrombosis (sinistral varicies) (2). In these cases, continued arterial flow into the spleen leads to distension of collateral circulation out of the spleen, generally through the short gastric veins. Figure 1 shows an image from VH Dissector Pro (Touch of Life Technologies: Aurora, Colorado) which illustrates the relationship of the spleen to stomach to portal circulation. Gastric varices can develop if splenic venous outflow is obstructed.

To further explore this regional anatomy, a Visible Human model of the portal, splenic superior mesenteric veins, with the stomach, spleen and splenic artery is shown in Figure 2. This anatomy can be further explored by entering into the Visible Human database from the link below Figure 2.

Video Clip 1 shows an example of a case of isolated gastric varices in a woman who had a mucinous cystadenocarcinoma in the splenic hilum, which obstructed her splenic vein and led to recurrent gastric bleeding. It is important to recognize isolated gastric varices due to splenic vein thrombosis since this can be completely corrected by splenectomy.

Most of the time, however, gastric varices are due to portal hypertension. In these cases, other management options must be employed. This issue of VHJOE provides a review on the endoscopic management of gastric varices by Dr. John Goff.

We hope that this review and the associated anatomy learning tools will be of use to our readers.

References

1. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004 Apr;126(4):1175-89. Review. <Related link>

2. Goldberg S, Katz S, Naidich J, Waye J. Isolated gastric varices due to spontaneous splenic vein thrombosis. Am J Gastroenterol. 1984 Apr;79(4):304-7. <Related link>