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Acute gastric variceal bleeding is a rare but serious complication of portal hypertension. Initial therapy for bleeding gastric varices focuses on acute hemostasis. In this regard, endoscopic cyanoacrylate injection (ECI) is the first-line approach.

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Aims: Due to the expensiveness and unavailability of endoscopy management in Tanzania, the management outcomes of variceal bleeding are unknown. The objective of this study was to assess the management outcomes of patients with variceal bleeding.

Methods: This was a retrospective study conducted between April 2012 and April 2022.

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Secondary Prophylaxis of Cirrhotic Gastric Variceal Bleeding: Addition of Non-Selective Beta-Blockers to Endoscopic Combined Treatment.

United European Gastroenterol J

December 2024

Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.

Background: It remains unclear whether the addition of non-selective beta-blockers (NSBB) provides further benefit after combined use of tissue adhesive and endoscopic variceal ligation for bleeding gastroesophageal varices.

Objective: This is the first cohort study comparing the secondary prophylactic efficacy of adding NSBB to combined endoscopic treatment in cirrhotic patients with gastric varices (without inclusion of isolated gastric varices [IGVs], which are rare in patients with cirrhosis without splanchnic thrombosis).

Methods: We retrospectively analyzed two matched large cohorts of cirrhotic patients with gastric varices who received combined endoscopic treatment and were assigned to receive NSBB treatment or not as secondary prophylaxis.

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The Baveno VII consensus, released in 2023, recommends that the endoscopic treatment of choice for managing bleeding gastric varices (GV) is endoscopic ultrasound (EUS)-guided treatment, specifically EUS-guided cyanoacrylate (CYA) glue injection. This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates, compared to other endoscopic techniques. Despite its efficacy, CYA injection for GV has been linked to rare but serious adverse events, such as glue embolization leading to pulmonary embolism, infection/bacteremia, splenic infarction, intra-procedural and post-procedural complications.

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BACKGROUND Arterioportal fistulas (APFs) are abnormal connections between the arterial and portal venous systems, leading to portal hypertension (PH) and symptoms such as gastrointestinal bleeding, splenomegaly, and hepatic pain. Symptoms typically appear by the age of 2 years in about 75% of cases. CASE REPORT A 7-year-old boy with an asymptomatic APF developed life-threatening complications following a Clostridium difficile infection.

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