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variceal bleed

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Oesophageal varices are varicosities of branches of the azygos vein which anastomose with tributaries of the portal vein in the lower oesophagus, due to portal hypertension in conditions such as cirrhosis of the liver.

Only about 30% of patients with varices ever bleed. There is more likelihood of bleeding with increasing size of the varicosities.

Gastroesophageal varices (gastric varices) are present in 50% of cirrhotics, and approximately 25% of patients with portal hypertension have gastric varices

  • commonly classified as GOVs (gastric varices in continuity with esophageal varices) and isolated gastric varices (IGVs)
    • further divided into GOV1 (GOVs along the lesser curve of the stomach), GOV2 (GOVs along the fundus), IGV1 (IGVs in the fundus), and IGV2 (IGVs in the gastric body, pylorus, or antrum)
    • although the prevalence and risk of bleeding of gastric varices are lower than those of esophageal varices, gastric variceal bleeding tends to be more severe, requires more transfusions, and is associated with higher mortality (approx 45%)
    • gastric varices tend to be larger and more tortuous compared with oesophageal varices, characteristics that, combined with their anatomical location (particularly fundic varices), make endoscopic management more challenging

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