A 55-year-old man with cirrhosis from chronic hepatitis C presents with acute hematemesis. Endoscopy confirms actively bleeding gastric varices (GOV2 type). Hemostasis is achieved endoscopically. Which is the most appropriate next step to prevent rebleeding from these varices?
- A Endoscopic glue injection (cyanoacrylate) at index session; consider TIPS if refractory ✓
- B Transjugular intrahepatic portosystemic shunt (TIPS) if rebleeding occurs
- C Start non-selective beta-blocker (propranolol) and repeat endoscopy in 1 week
- D Balloon-occluded retrograde transvenous obliteration (BRTO) as first-line
Correct answer: A. Endoscopic glue injection (cyanoacrylate) at index session; consider TIPS if refractory
Explanation
For gastric varices (especially GOV2/IGV1), endoscopic cyanoacrylate (glue) injection is the first-line hemostatic and rebleeding-prevention therapy, superior to band ligation. Non-selective beta-blockers are adjunctive but not sufficient alone for gastric varices. TIPS is reserved for failures. BRTO is an option for patients with prominent gastrorenal shunts, but glue injection is the established initial endoscopic therapy per Baveno consensus.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.