Treatment of Chronic Liver Failure in Liver Cirrhosis with Acute Bleeding from Cardiofundal Gastric Varices
Acute variceal haemorrhage from cardiofundal gastric varices represents a critical complication of liver cirrhosis. This protocol addresses the management of chronic liver failure when bleeding arises specifically from gastro-oesophageal varices type 2 (GOV2) or isolated gastric varices type 1 (IGV1).
Clinical scenario
The patient has established liver cirrhosis presenting with acute haemorrhage from cardiofundal gastric varices — either gastro-oesophageal varices type 2 (GOV2) or isolated gastric varices type 1 (IGV1). This anatomical distribution of varices, and the vascular collateral pathways involved, shape which interventions are appropriate.
Treatment approach (partial overview)
Management of fundal variceal bleeding in this setting involves interventional approaches targeting the portal-systemic pressure gradient and the feeding collateral vessels. The full protocol details the specific procedures, candidate selection criteria, and the role of collateral vessel anatomy in guiding the choice between options — access the complete regimen below.
References
DOI: 10.1016/j.jhep.2018.03.024
- Acute gastric VH should be treated medically, like oesophageal VH (I;1). Cyanoacrylate is the recommended endoscopic haemostatic treatment for cardiofundal varices (gastro-oesophageal varices type 2 or isolated gastric varices type 1) (I;2).
- TIPS with potential embolisation efficiently controls bleeding and prevents rebleeding in fundal VH (gastro-oesophageal varices type 2 or isolated gastric varices type 1) and should be considered in appropriate candidates (II-2;1).
- Selective embolisation (BRTO/BATO) may also be used to treat bleeding from fundal varices associated with large gastro/splenorenal collaterals, although more data is required (III;2).
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