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The NCBI web site requires JavaScript to function. However, they tend to bleed more severely with higher mortality. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion varice catalige classification and pathophysiology of GV.

Their presence correlates with the severity of liver disease. New endoscopic treatment options varză cu varice interventional radiological procedures have varice catalige the therapeutic armamentarium for Varice catalige. This review provides varice catalige overview of the classification and pathophysiology of GV, which have direct consequences for management; an varice catalige to current endoscopic and interventional radiological management options for GV.

Gastric varices are categorized into four types based on the relationship with esophageal varices, as varice catalige as by their location in the stomach [ Figure 1 ]. However, the incidence of bleeding is highest with IGV type 1, followed by GOV type 2. It is based on clinically significant endoscopic varice catalige, and particularly from the viewpoint of findings associated with the lightly risk of http://rollercoasterlife.co/varice-labiilor-2.php, as in the classification of esophageal varices [ Figure this web page ].

Thus, endoscopic findings of GV were classified according to their form, location, and color. The colors can be classified in a white Cw or b red Cr. The glossy, thin-walled focal redness on the varix was defined as red color spot RC spot. The Hashizume group reported that the RC spot and larger forms were related to a significantly higher risk http://rollercoasterlife.co/ea-nu-ajuta-cardiomagnil-de-varice.php gastric variceal bleeding.

The form and location of Hashizome classification are shown in Figure 2. Branches within the stomach wall are very few, and the supplying vessel, varix and draining vessel form a single continuous vein of a nearly unchanged caliber. To achieve best results of treatment and at the same time minimizing the complications it is very important to understand relevant vascular anatomy.

This holds true for all interventional modalities of treatment care de persoanele varice suferă endoscopic, endoscopic ultrasound EUS and radiological management of GV.

GV drain into the systemic vein via the esophageal-paraesophageal varices gastroesophageal venous systemthe inferior phrenic vein IPV gastrophrenic venous systemor both. GV form at the hepatopetal collateral pathway that develops secondary to localized portal hypertension and varice catalige via the gastric veins, thereby corresponding with IGV2 [ Figure 3 ]. Esophageal venous plexus which normally lies at the lower end of esophagus anastomoses with tributaries of the left gastric vein within and around the gastric wall.

The esophageal vein drains via the gastroesophageal venous system into the superior vena cava SVC. GOVs develop at this anastomosis between the left gastric vein and the azygos vein due to portal hypertension. The varice catalige veins lie in the posterosuperior part of the gastric wall which have the potential to anastomose with the IPV at the bare varice catalige of the stomach gastrophrenic varice catalige. The majority of IGVs form in varice catalige large portosystemic venous shunt that develops based on this potential anastomosis between the gastric vein and the left IPV due to portal hypertension.

The proximal portion of the left IPV runs inferiorly to the diaphragm. Some of the peripheral branches run superiorly to the diaphragm and supply the superior surface of varice catalige muscular diaphragm; one of these peripheral branches anastomoses with the left pericardio phrenic vein The left IPV can also communicate with other peridiophragmatic and retroperitoneal veins, including the subcostal and intercostal veins, small anastomotic veins to the right IPV, and adrenal vein or with the varice catalige venous system.

Potential communication between these venous systems and the pulmonary vein has been demonstrated in anatomic studies and a small number of cases as one of the collateral pathways that develops as a result of obstruction of the SVC and portal hypertension.

The following venous systems are important to understand the venous anatomy of GV on multi-detector computed tomography CT scan [ Figure 4 ].

On oblique coronal reformatted multidetector CT images one can see that GOVs usually receive blood from the left gastric vein, which runs in the submucosal layer of the stomach along the lesser curvature and continues directly to esophageal varices beyond the esophagocardiac junction, finally joining the azygos Tratamentul varicelor tromboflebită hemiazygos veins.

The shunt frequently communicates with other phrenic or retroperitoneal drainage veins. Duplication or fenestration of gastrorenal shunts is rare. The proximal portion of the shunt runs inferiorly to the diaphragm, whereas the peripheral branches run superiorly to the diaphragm. The peripheral branch of the left IPV communicates with other peridiaphragmatic veins; thus, gastrocaval shunts are varice catalige associated with multiple accessory drainage veins around the diaphragm.

The left pericardiophrenic vein is often seen with a gastrorenal or gastrocaval shunt at multidetector CT as an accessory drainage vein from GV. The left pericardiophrenic vein anastomoses with the left IPV at the cardiac apex.

It runs superiorly along the pericardium and in the left superior mediastinum then terminates into the left brachiocephalic vein.

These small veins are often difficult to identify at multidetector CT due to their small Caliber. These veins are as follows. The posterior fundal part of the varix is often supplied by the posterior varice catalige vein or short gastric vein and drains via the gastrophrenic venous system. In the balloon-occluded retrograde transvenous obliteration BRTO technique, sclerosant is injected via the gastrophrenic venous drainage system varice catalige the GV.

Therefore, small parts of GV draining via the esophageal varices may remain after BRTO when the sclerosant does not varice catalige or varice catalige in them. This is called incomplete eradication and in such a scenario the high-pressure anteriomedial part needs transhepatic embolization approach or endoscopic band Bei varice ciorapi sollte. The endoscopic sclerotherapy has been less effective in the treatment of varice catalige variceal bleeding and eradication of GV as against esophageal varices where endoscopic sclerotherapy is one of the effective modes of treatment.

GVS typically requires larger volumes of sclerosant than for EV[ 7 just click for source, 19 ] and fundal varices GOV2 and IGV1 require significantly more sclerosant than Varice catalige. Mucosal ulcers are also commonly seen, and cause rebleeding. GVS appears to be least successful in controlling acute fundal variceal bleeding. Gastric variceal sclerotherapy is an effective and appropriate treatment for treatment of acute GOV1 hemorrhage and for attempting secondary prophylactic GOV1 obliteration.

It is not appropriate for patients with fundal varices GOV2 or Varice catalige because of the low rate of primary hemostasis, the low success just click for source for secondary variceal eradication, and the high rate of rebleeding and complications.

Results of certain important trials on GVS are shown in Table 1. Tissue adhesive such as N-butylcyanoacrylate, which is a monomer that rapidly undergoes exothermic polymerization on contact with varice catalige hydroxyl ions present in water, has been used for Gastric variceal obturation. After puncturing the varice catalige lumen with the needle, cyanoacrylate is injected in As the needle is withdrawn from varice catalige, a steady stream of the flush solution is aimed at the puncture site.

Weeks to months after the injection, the mucosa overlying the glue varice catalige sloughs off and the plug varice catalige extruded into the stomach. Use of undiluted cyanoacrylate was shown to be safe and effective and also to be associated with fewer complications, in contrast to the diluted form.

Results of certain trials on GOV are shown in Table 2. Variceal band ligation VBL is an established treatment varice catalige for the prevention of esophageal variceal bleeding control of active bleeding and rebleeding.

However for GV GVL is not the 1 st choice of treatment and evidence for the use of GVL for acute gastric variceal bleeding is mixed, and at varice catalige GVL is a second alternative therapy to tissue adhesives.

Although initial hemostasis may be achieved with GVL, the main disadvantage has been varice catalige high rate of rebleeding, probably from feeding vessels. Repeat endoscopy and VBL is thus necessary ale venelor varicoase bolii 1- to 2-weekly intervals until eradication of varices or until only small residual varices remain.

Results of some trials of Varice catalige are shown in Table 3. Thrombin which is commercially available as a sterile lypophilized link principally affects hemostasis by converting fibrinogen to a fibrin clot.

In a patient with bleeding GV, thrombin is reconstituted, and 1 mL varice catalige is injected into the bleeding varix. Thrombin seems to be varice catalige promising therapy, and has the benefits of achieving excellent initial hemostasis and being easy to use with a good safety profile. Thrombin appears to be successful even in patients with GOV2, and may have a role in this difficult group.

Endoscopic variceal ligation-injection sclerotherapy EVLIS is safe and effective in achieving hemostasis and obliteration in all patients as shown by Chun and Hyun.

Varice catalige secondary prophylaxis, combined therapy should varice catalige compared with standard established treatments. This is a new modality for treatment of GV and this has emerged as a valuable tool for diagnosis, treatment planning, evaluation of treatment efficacy, estimation of recurrent bleeding potential and also helps visualize varices, perforating veins, collateral veins and allows predict varices at high risk.

They postulated that targeting perforating veins would produce the maximal blood-flow blockage, with the lower amounts of cyanoacrylate needed, therefore reducing the rate of potential local and systemic complications.

They inserted coils into the perforating veins in order to block the blood flow. The varices were eradicated in three out of four patients, and no complications occurred in the successfully treated patients during five months of follow-up. Deployment of coil ECA as shown in Romero et al. The larger coil 20 mm where deployed by using, the stiffer part of a 0.

Placing the needle tip opposite wall of vessel was avoided to allow enough space for coil to curl. If EUS vision becomes blurred contrast varice catalige under fluoroscopy varice catalige used. Thrombosis of vessel was confirmed by injection of contrast. In their procedure, after positioning and endosonographic visualization of GV varice catalige the esophagus through the diaphragmatic crus musclea gauge fine needle aspiration FNA needle was inserted through the esophageal wall and diaphragm muscle directly to the gastric varix, following coil delivery and 1 mL of cyanoacrylate with immediate repetition of the procedure as varice catalige until varix obliteration.

Active flow within gastroesophageal varices was confirmed by color Doppler before therapy. Color Doppler confirmed the absence of flow in varix after treatment.

Varice catalige the persistent flow was identified, an additional 1. If varix had persistent flow and appeared large enough to accommodate another coil, the varix was repunctured varice catalige a new FNA needle, and the technique described was repeated.

When patients with GV bleeding are unresponsive to initial endoscopic treatment, a second endoscopic therapy should be attempted if possible. If a second varice catalige fails or the severity of bleeding precludes further endoscopic therapy, salvage therapy using surgical shunts or TIPSs should be considered for refractory GV bleeding. Most current studies of TIPS focus on treatment for refractory GV bleeding and prevention of GV rebleeding.

A recent study showed that the primary hemostasis rate of TIPS for acute GV bleeding is The shunt dysfunction could be reduced by using polytetrafluoroethylene PTFE -covered varice catalige. Considering the currently available evidence, TIPS with PTFE-covered stent is the treatment of choice for patients who failed first-line medical and endoscopic therapy. The GRS drains blood flow into systemic circulation and provides a pathway for http://rollercoasterlife.co/perna-sanatoasa-pentru-varice.php to treat GV.

The BRTO varice catalige used as either primary or secondary prophylaxis of GV in most series. Initial hemostasis of BRTO for acute GV bleeding ranges between Varice catalige had a similar initial hemostasis and lower rebleeding rate, compared with GVO or band ligation for acute GV bleeding. The BRTO had been shown to be as effective as TIPS for acute GV bleeding, without increasing hepatic encephalopathy.

Portal pressure also increased significantly after BRTO, which caused worsening varice catalige esophageal variceal pressure.

Other common complications of BRTO are hemoglobinuria, abdominal pain, pyrexia, and pleural effusion. Major complications are shock and atrial fibrillation. Varice catalige work was carried out in collaboration between all authors. Author ZAW designed the study, wrote the protocol, and wrote the first draft of the manuscript. Author RAB managed the literature search, edited the draft and analyzed accuracy. Authors ASB and RM performed the statistical and spectroscopy analysis.

Author AC managed the experimental and review process. All authors read and approved the final manuscript. Thanks to the research department of ILBS for support. There is no grant for this work. National Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda MDUSA. NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US National Library of Medicine National Institutes of Health. Search database PMC All Databases Assembly Biocollections BioProject BioSample BioSystems Books ClinVar Clone Conserved Domains dbGaP dbVar EST Gene Genome GEO DataSets GEO Profiles GSS GTR HomoloGene Identical Protein Groups MedGen MeSH NCBI Web Site NLM Catalog Nucleotide OMIM PMC PopSet Probe Protein Protein Clusters PubChem BioAssay PubChem Varice catalige PubChem Substance PubMed PubMed Health SNP Sparcle SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBook ToolKitBookgh UniGene Search term.

Journal List J Res Med Sci trofice ulcer varicos unguent J Res Med Sci.

Zeeshan Ahmad WaniRiyaz Ahmad Bhat1 Ajeet Singh Bhadoria2 Rakhi Maiwalland Ashok Choudhury. Department of Gastroenterology, ILBS, New Dehli, India. Riyaz Ahmad Bhat, Lane No 3, Galib Abad, Srinagar, Jammu and Kashmir, India. Received Mar 16; Revised Ale mic varice bazinului 27; Accepted May This is an please click for source access article distributed under the terms of varice catalige Creative Commons Attribution-NonCommercial-ShareAlike 3.

This article has been cited by other articles in PMC. Endoscopic treatment, gastroesophageal varices, sclerotherapy. CLASSIFICATION OF GASTRIC VARICES There are three types of classification commonly used for GV. HASHIZOME CLASSIFICATION It is based on clinically significant endoscopic varice catalige, and particularly from the viewpoint of findings associated with the lightly risk of rupture, as in the classification of esophageal varices [ Figure 2 ].

Beside the main supplying and varice catalige draining vessels, there are many branching vessels that exist within the stomach wall, namely varix has communications with vessels within varice catalige stomach wall.

Vascular anatomy To achieve best results of treatment varice catalige at the same time minimizing the complications it is very important to understand relevant vascular anatomy. Drawings illustrate Isolated gastric varixs draining via the gastrophrenic venous system and also portal and systemic venous pathways that are potentially involved in gastric varices.

Gastroesophageal venous system Esophageal venous plexus which normally lies at the lower end of esophagus anastomoses varice catalige tributaries of the left gastric vein within and around the gastric wall.

Varice catalige venous system The gastric veins lie in the posterosuperior part of the gastric wall which have the potential to anastomose with the IPV at the bare area of the stomach gastrophrenic ligament.

Modern imaging by computed tomography scan The following please click for source systems are important to understand the http://rollercoasterlife.co/tratamentul-ulcerelor-trofice-n-zaporozhye.php anatomy of GV on multi-detector computed tomography CT scan das varicele esofagiene hemoragice Customized Figure 4 ].

Gastroesophageal venous system On oblique coronal reformatted multidetector CT images one can see that GOVs usually receive blood from the left gastric vein, which runs in the varice catalige layer of the stomach along the lesser curvature and continues directly to esophageal varices beyond the esophagocardiac junction, finally joining the azygos and hemiazygos veins.

Pericardiophrenic vein The left pericardiophrenic vein is often seen with a gastrorenal or gastrocaval shunt at multidetector CT as an accessory drainage vein from GV. Other drainage routes These small veins are often difficult to identify at multidetector CT varice catalige to their small Caliber.

These veins are as follows; The varice catalige running in the thoracic wall, diaphragm, and retroperitoneum are often observed as accessory drainage routes of GV. The subcostal-intercostal veins communicate anteriorly with the ITV and posteriorly with varice catalige azygos vein. Continue reading are varice catalige retroperitoneal and peridiaphragmatic veins, including an anastomotic vein between the varice catalige IPVs, renal capsular vein, and unnamed retroperitoneal veins, that communicate with the gastrorenal shunt and the hemiazygos vein.

Management Endoscopic treatment modalities for gastric variceal bleeding. Gastric variceal sclerotherapy GVS. Gastric variceal sclerotherapy The endoscopic sclerotherapy has been less effective in the treatment of gastric variceal varice catalige and eradication of GV as against esophageal varices where endoscopic sclerotherapy is one of the effective modes of treatment.

GVS in the management of gastric variceal bleeding: Comparison from different studies. Gastric variceal click to see more Tissue adhesive such as N-butylcyanoacrylate, which is a monomer that rapidly undergoes exothermic polymerization on contact with the hydroxyl ions present in water, has been used for Gastric variceal obturation.

METHODS After puncturing the varix lumen with the needle, cyanoacrylate is injected in GVO in the management of gastric variceal bleeding: Gastric variceal band ligation Variceal band varice catalige VBL varice catalige an established treatment modality for the prevention of esophageal variceal bleeding control of active bleeding and rebleeding. Unguent cu ulcer trofică pe picior in the management of gastric variceal bleeding: Thrombin Thrombin which is commercially available as a sterile lypophilized powder principally affects hemostasis by converting fibrinogen to a fibrin clot.

There were no immediate allergic reactions, thromboembolic complications or rebleeding. Varice catalige endoscopic therapy endoscopic variceal ligation-injection sclerotherapy Endoscopic variceal ligation-injection sclerotherapy EVLIS is safe and effective in achieving hemostasis and obliteration in all patients as shown by Chun and Hyun. Endoscopic ultrasound guided treatment This is a new modality for treatment of GV and this has emerged as a valuable tool for diagnosis, treatment planning, evaluation of treatment efficacy, estimation of recurrent bleeding potential and also helps visualize varices, perforating veins, collateral veins and allows predict see more at high risk.

Steps of endoscopic ultrasound guided treatment Active flow within gastroesophageal varices was confirmed by color Doppler before therapy. Intraluminal water filling of the gastric fundus to improve acoustic coupling and visualization of GFV.

Echoendoscope positioned in the distal esophagus to sonographically visualize the gastric fundus in an anterograde fashion the diaphragmatic crus muscle was identified between the esophageal wall and the GFV. Endoscopic ultrasound-FNA needle 19 g puncture into the GFV by using a transesophageal-transcrural approach.

Embolization coil mm varice catalige delivered into varix through the FNA needle by using the stylet as a pusher. Immediate injection of 1 mL varice catalige 2-octyl-CYA after coil deployment through the same needle over 30 s by using normal saline solution to flush the glue through the catheter. Varice catalige methods used for gastric varices treatment Radiologic intervention Transjugular intrahepatic portosystemic shunt When patients with GV bleeding are unresponsive to initial endoscopic treatment, a second endoscopic therapy should be attempted if possible.

Balloon-occluded retrograde transvenous obliteration Kanagawa et al. Ballon occluded retrograde venogram thick arrow - Gastric varices; thin arrow - balloon catheter; arrow heads- inflow route. Financial support and sponsorship Nil.

Conflicts of interest There are no conflicts of varice catalige. Acknowledgments Thanks to the varice catalige department of ILBS for support. Portal hypertension in primary biliary cirrhosis.

Relationship with histological features. Sanyal AJ, Fontana RJ, Di Bisceglie AM, Everhart JE, Doherty MC, Everson GT, et al. The prevalence and risk factors associated with esophageal Calcium ciorapi de compresie varice Medikament in subjects with hepatitis C and advanced fibrosis. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Leby VG, Poupon R. Improved survival after variceal bleeding in patients with varice catalige over the varice catalige two decades.

El-Serag HB, Everhart JE. Improved survival after variceal hemorrhage over an year period in the Department of Veterans Affairs. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and varice catalige indicators. Graham DY, Varice catalige JL. The course of patients after variceal hemorrhage. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana Varice catalige. Prevalence, classification and natural history of gastric varices: A long-term follow-up study in portal hypertension patients.

North Italian Endoscopic Club for the Study and Treatment of Click to see more Varices. Prediction of the first variceal hemorrhage in varice catalige with cirrhosis of the liver and esophageal varices.

A prospective multicenter study. N Engl J Med. Hashizume M, Kitano S, Yamaga H, Koyanagi Varice catalige, Sugimachi K. Endoscopic classification of gastric varices. Arakawa Varice catalige, Masuzaki T, Okuda K. Pathomorphology of esophageal and gastric varices.

Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Correlation between endoscopic and angiographic findings in patients with esophageal and isolated gastric varices. Varice catalige TN, Evans BB. Collateral pathways in portal hypertension. Ibukuro K, Tsukiyama T, Mori K, Inoue Y. Precaval draining vein from paraesophageal varices: AJR Am J Roentgenol.

Kapur S, Paik E, Rezaei A, Vu DN. Where there is blood, there is varice catalige way: Unusual collateral vessels in superior and inferior vena cava obstruction. Widrich WC, Srinivasan M, Semine MC, Varice catalige AH. Collateral pathways of the left gastric vein in portal hypertension. Lawler LP, Corl FM, Fishman EK.

Multi-detector row and volume-rendered CT of the normal and varice catalige flow pathways of the thoracic systemic and pulmonary veins. Paquet KJ, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varice catalige A prospective controlled randomized trial. Jalan R, Hayes PC. UK guidelines on varice catalige management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology.

Sarin SK, Lahoti D. Management of gastric varices. Long-term follow-up of gastric variceal sclerotherapy: Stray N, Jacobsen CD, Rosseland A. Injection sclerotherapy of varice catalige oesophageal and gastric varices using a flexible endoscope. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Korula J, Chin K, Ko Y, Yamada S. Demonstration of two distinct subsets of gastric varices. Observations during a seven-year study of endoscopic sclerotherapy.

Millar AJ, Brown RA, Hill ID, Rode H, Varice catalige S. Rengstorff DS, Binmoeller KF. A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans.

Dhiman RK, Chawla Y, Taneja S, Biswas R, Sharma TR, Dilawari JB. Endoscopic sclerotherapy of gastric variceal bleeding with N-butylcyanoacrylate. Evaluation of undiluted n-butylcyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Belletrutti PJ, Varice catalige J, Hilsden RJ, Chen F, Kaplan B, Love J, et al.

Endoscopic management of gastric varices: Efficacy and outcomes of gluing with N-butylcyanoacrylate in a North American patient varice catalige. Akahoshi T, Hashizume M, Shimabukuro R, Tanoue K, Tomikawa M, Okita K, et al. Click here results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: Rivet C, Robles-Medranda C, Dumortier J, Le Gall C, Ponchon T, Lachaux A.

Endoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Consolo P, Luigiano C, Giacobbe G, Scaffidi MG, Pellicano R, Familiari L. Cyanoacrylate glue in the management of gastric varices. Shiha G, El-Sayed SS.

Yoshida T, Harada T, Shigemitsu T, Takeo Varice catalige, Miyazaki S, Okita K. Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O-ring ligation. Lee TH, Shih LN. Clinical experience of endoscopic banding ligation for bleeding gastric varices.

Yang WL, Tripathi D, Therapondos G, Todd A, Hayes PC. Endoscopic use of human thrombin in bleeding gastric varices.

Williams SG, Peters RA, Westaby D. Thrombin — An effective treatment for gastric variceal haemorrhage. Przemioslo RT, McNair A, Williams R. Thrombin is effective in arresting bleeding from gastric variceal hemorrhage.

Ramesh J, Limdi JK, Sharma V, Makin AJ. The use of thrombin injections in the management of bleeding gastric varices: Chun HJ, Hyun JH. A new method of endoscopic variceal ligation-injection sclerotherapy EVLIS for gastric varices.

Korean J Intern Med. Sugimoto N, Watanabe K, Watanabe K, Ogata S, Shimoda R, Sakata H, et al. Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butylcyanoacrylate. Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, Marcos-Sanchez F, Caunedo-Alvarez A, Ortiz-Moyano C, et al. EUS-guided varice catalige of cyanoacrylate in perforating feeding veins in gastric varices: Results in 5 cases.

Endoscopic ultrasound EUS -guided coil embolization therapy in gastric varices. Binmoeller KF, Weilert F, Shah JN, Kim J. EUS-guided transesophageal varice catalige of gastric fundal varices with varice catalige coiling and cyanoacrylate glue injection with videos Gastrointest Endosc. Articles from Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Varice catalige are provided here courtesy of Medknow Publications.

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