Endoscopic treatment of fundal gastric varices in patients with liver cirrhosis
DOI:
https://doi.org/10.52556/2587-3873.2025.2(104).02Keywords:
liver cirrhosis, fundal gastric varices, endoscopichemostasis, fibrin glueAbstract
Fundal gastric varices represent a severe complication of portal hypertension in patients with liver cirrhosis, characterized by a high risk of bleeding and elevated mortality. Modern endoscopic management involves the use of tissue adhesives (thrombin, fibrin glue) as an alternative to cyanoacrylate injection, especially in cases with impaired liver function. This retrospective study included 46 patients with liver cirrhosis and bleeding from fundal gastric varices, treated endoscopically through obliteration using ex tempore prepared fibrin glue. Inclusion criteria targeted exclusively patients with bleeding fundal gastric varices, and liver function was assessed according to the Child-Pugh classification. Primary hemostasis was achieved in 95.7% of cases. The overall rebleeding rate was 13.0%, with no major complications. The overall mortality rate was 15.2%, predominantly associated with post-hemorrhagic liver failure. Rebleeding episodes mainly occurred from newly formed collaterals, not from the initially treated varices. Obliteration of fundal gastric varices with fibrin glue is an effective and safe method of hemorrhage control in patients with liver TRATAMENTUL ENDOSCOPIC AL VARICELOR GASTRICE FUNDALE LA PACIENȚII CU CIROZĂ HEPATICĂ Gheorghe ANGHELICI1, Oleg SAVIN3, Viorel MORARU1, Sergiu PISARENCO1, Ion PANICI3, Galina PAVLIUC1, Tatiana ZUGRAV3, Marina CEBAN2 , Ana OTGON3 1Catedra de chirurgie nr. 2, IP USMF Nicolae Testemițanu, 2Laboratorul Hepatochirurgie, IP USMF Nicolae Testemițanu, 3IMSP SCM Sfânta Treime, Chișinău cirrhosis, including those with limited hepatic reserves. The technique provides a viable alternative to cyanoacrylate, with minimal risk of embolic and local complications, supporting its inclusion in clinical practice guidelines.
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