The treatment of gastric fundal varices--endoscopic therapy versus interventional radiology.

BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration.

METHODOLOGY: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups.

RESULTS

Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups.

CONCLUSIONS

The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.