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. Author manuscript; available in PMC: 2016 Jul 1.
Published in final edited form as: Gastrointest Endosc Clin N Am. 2015 Jun 5;25(3):491–507. doi: 10.1016/j.giec.2015.03.004

Figure 2. Suggested algorithm for management of gastric variceal hemorrhage.

Figure 2

Type 1 gastroesophageal varices (GOV1) are believed to be extension of esophageal varices and are best treated with band ligation. Cyanoacrylate glue can be applied as an alternate therapy. The choice of endoscopic therapy for bleeding fundic varices is EVO with cyanoacrylate glue. While EIS and thrombin may come as an alternate, TIPS should be considered in situations where EVO is not available. Alternately, balloon-occluded retrograde transvenous obliteration should be considered when TIPS is not suitable. If splenic vein thrombosis is identified as the cause of bleeding fundic varices, either splenectomy or partial splenic embolization should be considered.

EGD, esophagogastroduodenoscopy, EVBL, endoscopic variceal ligation, EVO, endoscopic variceal obturation, EIS, endoscopic injection sclerotherapy, GOV1, gastroesophageal varices type 1, GOV2,gastroesophageal varices type 2, IGV1, isolated gastric varices type 1, TIPS transjugular intrahepatic portosystemic shunt, BRTO, balloon-occluded retrograde transvenous obliteration, PSE, partial splenic embolization, NSBB, nonselective beta-blocker