Liver cirrhosis
ICD-10 K74 · ICD-11 DB93.1

Acute Bleeding from Cardiofundal Gastric Varices in Liver Cirrhosis

Acute haemorrhage from cardiofundal gastric varices — classified as gastro-oesophageal varices type 2 (GOV2) or isolated gastric varices type 1 (IGV1) — represents a high-risk emergency in liver cirrhosis. These fundal varices behave differently from oesophageal varices and require a distinct clinical approach.

Clinical Scenario

The patient presents with active or recent acute bleeding arising from cardiofundal gastric varices — specifically GOV2 (gastro-oesophageal varices type 2) or IGV1 (isolated gastric varices type 1) — in the setting of established liver cirrhosis.

Treatment Approach Partial overview

Management of fundal variceal haemorrhage in appropriate candidates may involve interventional radiological procedures aimed at controlling bleeding and reducing the risk of rebleeding. In selected cases, alternative embolisation techniques targeting large associated collateral vessels may also be considered. The full clinical algorithm — including candidate selection, sequencing, and procedural detail — is available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2018.03.024

  1. Cyanoacrylate is the recommended endoscopic haemostatic treatment for cardiofundal varices (gastro-oesophageal varices type 2 or isolated gastric varices type 1) (I;2).
  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).
  3. 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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