Nagral, SShah, SGandhi, MMathur, S K1999-04-132009-05-291999-04-132009-05-291999-04-13Nagral S, Shah S, Gandhi M, Mathur SK. Bleeding isolated gastric varices: a retrospective analysis. Indian Journal of Gastroenterology. 1999 Apr-Jun; 18(2): 69-72http://imsear.searo.who.int/handle/123456789/64248OBJECTIVE: Isolated gastric varices (IGV) are rare and are believed to be associated with left-sided portal hypertension. We studied patients presenting with bleeding from IGV and compared them with those bleeding from both esophageal and gastric varices. METHODS: A retrospective analysis of 14 patients with bleeding from IGV was carried out. Portovenography findings (pattern of collateralization and natural shunts) in these patients were compared with a matched group of 69 patients with both esophageal and gastric varices. RESULTS: Of 14 patients with IGV, 2 had isolated splenic vein thrombosis and 12 had generalized portal hypertension. Portovenograms in 11 of the latter 12 revealed predominantly 'left-sided' collateralization in 8 patients as compared to 17 of 69 (25%) patients with esophageal and gastric varices (p = 0.004); natural shunts were seen in 6 of 11 cases and 15 of 69 (22%) patients in the two groups, respectively (p = 0.05). Abdominal devascularization operation gave good short- and long-term control of bleeding. CONCLUSIONS: Contrary to belief most patients with isolated gastric varices may have generalized portal hypertension rather than splenic vein obstruction as the cause and hence should be treated by a more extensive procedure than just splenectomy. The IGV could be a result of predominant collateralization to the retroperitoneal area (left-sided collateralization and natural shunts) rather than the usual pattern to the azygos system which results in esophageal varices.engEsophageal and Gastric Varices --epidemiologyFemaleGastrointestinal Hemorrhage --epidemiologyHumansHypertension, Portal --epidemiologyIndia --epidemiologyMaleMiddle AgedRetrospective StudiesJournal Article