FIGURE 2.

An approach to the management of gastrofundal varices. In patients with acute variceal bleeding from gastrofundal varices, endoscopic therapy (cyanoacrylate injection or endoscopic ultrasound–guided therapy), TIPS, or RTO can be used as first-line therapy. Endoscopic therapy for gastrofundal varices is available in select centers. Choice between TIPS and/or RTO depends on multiple factors, including vascular anatomy, liver function, and availability of local expertise. Patients with rebleeding after endoscopic therapy should undergo TIPS. Abbreviations: EUS, endoscopic ultrasound; RTO, retrograde transvenous obliteration.