胃静脉曲张的内镜治疗问题与进展OA

Gastric variceal bleeding,a severe complication of cirrhotic portal hypertension,is characterized by a high risk of hemorrhage and a mortality rate.Endoscopic therapy is recommended as the first-line treatment for gastroesophageal varices in relevant guidelines.Elevated portal pressure,concomitant tumors,portal vein thrombosis,and large extramural vessels may affect the efficacy of endoscopic treatment.In such cases,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as an alternative,though its application is limited by complications such as hepatic encephalopathy.In recent years,endoscopic ultrasound(EUS)-guided therapy has demonstrated significant efficacy.The advantages of EUS-guided variceal therapy include:preoperative risk stratification by identi-fying high-risk patients with large extramural vessels;real-time visualization to enable precise injection of cyanoacrylate glue and placement of coils,which reduces the risk of ectopic embolism and allows simultaneous embolization of intramural and extramural ves-sels;and immediate postoperative evaluation to confirm the complete embolization of varices and their perforating branches.Based on a comprehensive clinical assessment,selecting EUS-guided therapy,which facilitates personalized treatment planning,or alternative approaches such as interventional radiology,is the most important factor in reducing bleeding and improving prognosis.