GASTRIC FUNDIC VARICES: HEMODYNAMICS AND NON‐SURGICAL TREATMENT

The hemodynamics and non‐surgical treatment of gastric fundic varices (FV) are reviewed. FV are more frequently supplied by the short and posterior gastric veins than esophageal varices (EV), and are formed mostly by large spontaneous shunts in which the gastric or splenic vein is continuous with the left renal vein via the inferior phrenic veins and the suprarenal vein (so‐called gastric‐renal shunt). Concomitant collaterals such as EV, para‐esophageal vein, and para‐umbilical vein were also observed in nearly 60% of FV. Endoscopic injection sclerotherapy (EIS) with Histoacryl is thought to be the most approved treatment for hemorrhage from FV, but repeated treatment for residual FV and care for ensuing hepatic failure are required. Balloon‐occluded retrograde transvenous obliteration (B‐RTO) is a notable interventional radiological procedure specially developed for the elective or prophylactic treatment of FV. If the procedure is technically successful, long‐term eradication of treated FV is found in most patients without recurrence. B‐RTO includes another significance, obliteration of the unified portal‐systemic shunt. Follow‐up abdominal CT scan revealed a high incidence of long‐term obliteration of the gastric‐renal shunt after B‐RTO. Benefits such as elevation of serum albumin, improvement in 15‐min retention rate of indocyanine green, decrease in blood ammonia levels, and improvement of encephalopathy are sometimes observed.