Course Description
There is often confusion amongst gastroenterologists as to the best treatment for bleeding gastric varices (GV), especially in the United States, where glue injection is not FDA-approved. Thus, our main objective of this video is to understand the management of bleeding gastric varices in the US.
Several modalities are available for treatment of bleeding GV: variceal ligation, glue injection, TIPS and balloon-occluded retrograde transvenous obliteration (BRTO). We present a video of bleeding gastric varices and discuss techniques of glue injection with assistance using Doppler endoscopic probe (DEP) and confirmation of obliteration of subsurface blood flow by DEP. In addition, we describe TIPS and BRTO as options for treatment of bleeding GV.
We present studies on efficacy and safety of glue injection and BRTO. In conclusion, we recognize that TIPS is still the most widely used treatment of bleeding GV in the US, however, in centers with glue expertise, it’s reasonable to begin with glue injection, and reserve TIPS for glue failures. Glue is less expensive and less invasive than endovascular treatments, such as TIPS and BRTO, and can be easily used in acute hemorrhage. BRTO requires specific expertise, needs several hours to complete and cannot be performed in acute hemorrhage.
See a
preview of this video content
here.
Total run time = 30 minutes
Learning Objectives
- Define the classification of the gastric varices (GV).
- Understand the general management of bleeding GV.
- Recognize the role of endoscopic glue therapy versus endovascular treatment of GV.
Online CME Release Date: June 1, 2018
CME Expiration Date: June 1, 2021
Expected Time of Activity Completion: 30 minutes
Authors
Primary Authors
Perica Davitkov, MD
AnnMarie Kieber-Emmons, MD
Secondary Authors
Gerald Isenberg, MD
Indravadan Patel, MD
Richard Wong, MD
Instructions
This CME activity consists of an ASGE video, followed by a post-assessment. All materials required to complete the activity, including the video, are contained within the activity.
To complete this activity,
- View the video.
- Complete the Post –assessment by selecting the single best answer for each multiple choice question. You have 3 chances to score above an 80%.
- After you pass the test, you complete the evaluation and then you can print a CME certificate. Exams can be saved to access at a later date.
You may complete the activity in one sitting, or you may save your work in progress and complete it at a later date. However, to earn CME credits, you must complete the activity prior to the CME expiration date.
Completed CME will be tracked in your transcript and you can print a record of this CME activity at any time.
Hardware/Software Requirement
Windows Requirements:
Operating system: Windows 7+
Browser: Internet Explorer 8+, Firefox 10+, Google Chrome 10+ Internet connection: DSL, cable modem, or other high-speed connection
Flash: Adobe® Flash® Player 12+
Macintosh Requirements:
Operating system: Mac OS X 10.6.8+
Browser: Mozilla Firefox 10+, Safari 5+, Google Chrome 10+ Internet connection: DSL, cable modem, or other high-speed connection
Flash: Adobe® Flash® Player 12+
Contact Information
For technical difficulties, please contact ASGE between the hours of 8:30am and 5pm Central Time at 1-866-353-ASGE (2743). For questions related to content or CME credits, please email
education@asge.org.