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Gastric varices are dilated submucosal veins in the lining of the stomach, which can be a life-threatening cause of bleeding in the upper gastrointestinal tract.They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis.
Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular procedure used for the treatment of gastric varices.When performing the procedure, an interventional radiologist accesses blood vessels using a catheter, inflates a balloon (e.g. balloon occlusion) and injects a substance into the variceal blood vessels that causes blockage of those vessels.
Depending on the amount of the blood loss, symptoms may include shock. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine the hemoglobin.
Gastric antral vascular ectasia (GAVE) is an uncommon cause of chronic gastrointestinal bleeding or iron deficiency anemia. [ 1 ] [ 2 ] The condition is associated with dilated small blood vessels in the gastric antrum , which is a distal part of the stomach . [ 1 ]
Signs and symptoms of portal hypertension include: Abdominal swelling and tightness due to ascites, which is free fluid in the peritoneal cavity [1] Vomiting blood (hematemesis) from gastric or esophageal varices; Anorectal varices [8] Increased spleen size (splenomegaly), [1] which may lead to lower platelet counts (thrombocytopenia)
Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse.
The esophageal balloon should not remain inflated for more than six hours, to avoid necrosis. The gastric lumen is used to aspirate stomach contents. [citation needed] Generally, Sengstaken–Blakemore tubes and Minnesota tubes are used only in emergencies where bleeding from presumed varices is impossible to control with medication alone.
The lesser curvature of the stomach and abdominal esophagus are then devascularized, and the cardioesophageal branches of the left gastric vessels are ligated and divided. The esophagus and cardia are then entirely mobilized. The anterior gastric vagus nerve was previously divided and therefore pyloroplasty is performed.