Bleeding Gastric Varices: Frequency and Outcome

Background and aims: Gastric variceal bleeding is less frequent than esophageal varices bleeding but it still a serious cause of morbidity and mortality. The aim of study was to assess the frequency and identify the patients' outcome after management.

Patients and methods: The study was conducted on cirrhotic patients with upper gastrointestinal bleeding in the period from June 2016 to June 2017 who underwent esophago-gastro-duodenoscopy&subjected to complete history taking, clinical examination, laboratory investigations & abdominal US. 

Results: The study included 500 patients. In the endoscopic findings, bleeding from gastric varices (GV) was seen in 50 patients (10 %), bleeding from esophageal (EV) was detected in 400 patients (80 %), while bleeding from other sources was in 50 patients (10%).The mean age of GV patients was 56.64± 11.06; most of them were males 34 (68 %)& the most common etiology of the underlying liver cirrhosis& portal hypertension was HCV that was detected in 40 patients (80%).Only 35 patients (70%) had isolated GV type I & 15 patients (30%) had continuous Gastroesophogeal varices type 2 with red colour signs (Rc+) in 80% of the cases.PHG was seen in 48 patients(96%).Bleeding was more common between Child A patients although it was not significant. Also there were no significant differences between grades of gastric varices according to MELD score. As regards the outcome, 40% developed eradication, 38% died & 22% developed re-bleeding. Upon studying the predictors of mortality, we found that they had significantly lower albumin & higher ALT & AST levels. Early re-bleeding was more common among child A patients with moderately sized GV (F2), but the difference was not statistically significant. By multivariate analysis we found that were no independent predictors of rebleeding gastric varices.

Conclusion: frequency of bleeding GV was 10% among cirrhotic patient with upper GIT bleeding. No independent factors could predict the mortality or rebleeding among cirrhotic patients with bleeding GV by multivariate analysis.