Diagnostic Approach to Gastric Varices

First-Line Diagnostic Test

Upper endoscopy is the most accurate method for diagnosing gastric varices, allowing direct visualization and classification of varices, according to the American College of Radiology 1, 2
Endoscopy provides high accuracy in diagnosing the etiology of upper GI hemorrhage and can simultaneously offer therapeutic options, as recommended by the American College of Radiology 1
Gastric varices are classified during endoscopy according to their size and location, which guides management decisions, as stated by the Gut journal 2

Contrast-enhanced CT or MRI should be obtained routinely in patients with suspected gastric varices to identify inflow and outflow vessels, determine feasibility of interventional procedures, and detect portal or splenic vein occlusion, according to the American College of Radiology 1, 3
CT has been shown to detect gastric varices with high sensitivity and specificity, as reported by the American College of Radiology 1

For patients with compensated cirrhosis, a combination of non-invasive tests, including vibration controlled transient elastography (VCTE) with a cutoff of 19.5 kPa, can help determine the need for endoscopy, as recommended by the Gastroenterology journal 5, 6
Platelet count >150,000/mL combined with VCTE <19.5 kPa may identify patients at low risk for high-risk varices, according to the Gastroenterology journal 5, 6

In patients with acute variceal bleeding, endoscopy should be performed within 12 hours of presentation, as stated by the Gastroenterology journal 6
In patients with decompensated cirrhosis or known portal hypertension, endoscopic evaluation should be pursued regardless of elastography results, as recommended by the Gastroenterology journal 6