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Review
. 2020 Oct;26(4):444-460.
doi: 10.3350/cmh.2020.0022. Epub 2020 Oct 1.

Managing liver cirrhotic complications: Overview of esophageal and gastric varices

Cosmas Rinaldi Adithya Lesmana  1   2 , Monica Raharjo  1 , Rino A Gani  1
Affiliations
Review

Managing liver cirrhotic complications: Overview of esophageal and gastric varices

Cosmas Rinaldi Adithya Lesmana et al. Clin Mol Hepatol. 2020 Oct.

Abstract

Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians' guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

Keywords: Esophageal and gastric varices; Hypertension, Portal; Liver cirrhosis.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Relationship of portal hypertension and risk of varices development. HVPG, hepatic vein pressure gradient; EV, esophageal varices; GV, gastric varices; CSPH, clinically significant portal hypertension.
Figure 2.
Figure 2.
High-risk esophageal varices with red-color signs: (A) red wale markings, (B) cherry-red spots, and (C) hematocytic spots.
Figure 3.
Figure 3.
IGV1 (A, B) and high-risk gastric varices with red-color sign (C). IGV, isolated gastric varices.
Figure 4.
Figure 4.
Non-invasive methods for detection of esophagogastric varices [32].
Figure 5.
Figure 5.
Endoscopic variceal band ligation.
Figure 6.
Figure 6.
Management of patients with acute variceal bleeding. AVB, acute variceal bleeding; EGD, esophagogastroduodenoscopy; EV, esophageal varices; GOV1, type 1 gastroesophageal varices; GOV2, type 2 gastroesophageal varices; IGV, isolated gastric varices; EVL, endoscopic variceal ligation; EVO, endoscopic variceal obturation; TIPS, transjugular intrahepatic portosystemic shunt; BRTO, balloon-occluded retrograde transvenous obliteration.
See this image and copyright information in PMC

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