Endoscopy and Gastric Varices(Endoscopy, Jan-2026)

**Role of Endoscopy in Gastric Varices:**

Endoscopy is a critical tool in the diagnosis and management of gastric varices in patients with cirrhosis. Gastric varices are enlarged veins in the stomach that develop due to increased portal venous pressure, often associated with liver cirrhosis. When these varices bleed, they can lead to life-threatening hemorrhage, making endoscopic intervention essential.

**Study Insights:**

1. **Treatment Approaches:** In the study, two endoscopic strategies were compared:

• **Aggressive Endotherapy:** Obliteration of all visible gastric varices using cyanoacrylate glue, regardless of bleeding status or risk features.
• **Conservative Endotherapy:** Treatment limited to varices with stigmata of recent hemorrhage or high-risk features.

2. **Outcomes:**

• **Rebleeding Rates:** At one year, rebleeding rates were similar between the aggressive and conservative groups (18.2% vs. 15.0%).
• **Mortality:** All-cause mortality was also comparable, with a nonsignificant trend toward lower mortality in the aggressive group.
• **Efficiency:** Aggressive therapy achieved faster obliteration of varices and required fewer endoscopic sessions for GOV1 varices.

3. **Adverse Events:** The rates of complications were similar between the two groups, indicating that aggressive therapy did not increase the risk of adverse events.

**Conclusion:**

Endoscopy, specifically through the use of cyanoacrylate glue injection, is a highly effective method for managing gastric varices. The study suggests that while aggressive therapy may lead to faster variceal obliteration, it does not significantly improve rebleeding or mortality outcomes compared to a conservative approach. This highlights the importance of tailoring endoscopic treatment strategies to individual patient risk factors and clinical scenarios.