Endoscopic management of gastric varices

Understanding the basic pathophysiology and anatomy of gastric varices is critical to the appropriate management of acute variceal bleeding. The high morbidity and mortality of gastric variceal bleeding combined with poor response to treatments for esophageal variceal bleeding has demanded a highly differentiated approach. This review focuses on gastric fundal varices for which the most recent Baveno VI consensus guidelines recommend endoscopic cyanoacrylate-based therapy as first-line intervention. We discuss the evolution of endoscopic techniques, not only to achieve effective hemostasis but also to limit inherent risks and complications. Long-term data reveal that low rebleeding rates are feasible when gastric varices are completely obliterated. Both primary and secondary prophylaxis should become part of standard treatment algorithms.