Bleeding from gastric varices in portal hypertension: a modern view and the possibility of effective treatment

Esophagogastric variceal bleeding is a life-threatening complication of portal hypertension. At the same time, bleeding from gastric varices, compared with variceal esophageal hemorrhage similar in pathogenesis, is less common, but has more severe complications and high mortality. Features of gastric varices and some variants of their localization can adversely affect the effectiveness of endoscopic hemostasis measures. In such cases, the importance of surgical interventions that provide portal decompression or obliteration of the inflow tracts to the varix increases. First of all, this concerns such endovascular procedures as transjugular intrahepatic portosystemic shunting (TIPS), balloon ante- or retrograde transvenous obliteration, as well as combined techniques. It is known that in majority of clinical cases, variceal bleeding occurs most dramatically in patients with liver cirrhosis. For this reason, the use of minimally invasive rather than transabdominal surgery is preferred. The purpose of the review is to evaluate the current possibilities of effective treatment of bleeding from gastric varices due to portal hypertension.