2022 Webinar: Endovascular vs Endoscopic Management of Gastric Varices: Which is Better?-Endovascular vs Endoscopic Management of Gastric Varices: Which is Better?

Video Transcription

Video Summary

In this video transcript, Dr. Saad discusses the endovascular management of gastric varices, specifically focusing on BRTO (balloon-occluded retrograde transvenous obliteration). He explains the concepts of BRTO and different procedures within it, such as conventional BRTO, BATO (balloon-occluded antegrade transvenous obliteration), and accelerated BRTO. He discusses the anatomy of gastric varices and the techniques used in BRTO, including the placement of balloons, plugs, and coils. Dr. Saad also presents the outcomes and complications associated with BRTO, such as rebleeding rates, aggravation of esophageal varices, and portal hypertensive gastropathy. He concludes that BRTO is an effective treatment for gastric varices, with low rebleeding rates, but it does not necessarily translate into improved survival. <br /><br />In her presentation, Dr. Henry focuses on the endoscopic management of gastric varices. She discusses the incidental presentation of gastric varices and the need to determine the bleeding risk based on factors such as varix size, child-pugh status, and high-risk marks. She presents a randomized controlled trial comparing primary prophylaxis with cyanoacrylate injection and propranolol, which found that cyanoacrylate injection was superior in preventing bleeding, but not in improving survival. Dr. Henry also discusses the acute presentation of gastric variceal bleeding and the different treatment options such as band ligation, sclerotherapy, and balloon tamponade. She includes studies comparing cyanoacrylate injection and band ligation, which showed that cyanoacrylate was better in stopping acute bleeding, but there were no significant differences in complications or long-term mortality. Finally, Dr. Henry compares the outcomes of cyanoacrylate injection and BRTO for secondary prophylaxis, discussing a randomized controlled trial that found BRTO to be superior in preventing rebleeding. She concludes that for cardiofundal varices, BRTO is superior to cyanoacrylate in preventing rebleeding, but long-term survival does not appear to be significantly different between the two treatments.

Keywords

endovascular management

gastric varices

BRTO

conventional BRTO

BATO

accelerated BRTO

cyanoacrylate injection

band ligation

sclerotherapy

long-term survival