skip to main content

Bleeding gastric varices — ESEGH MCQ

Instant feedback + full explanation. One question, done properly.

HardGI BleedingBleeding gastric varicesESEGH

A 58-year-old man with decompensated cirrhosis presents with haematemesis. Following haemodynamic resuscitation, restrictive blood-product replacement, intravenous antibiotics and terlipressin, urgent endoscopy shows active spurting from a 25 mm isolated gastric fundal varix with no oesophageal extension (Sarin IGV1). Appropriate local expertise is available. Which endoscopic intervention is most appropriate for immediate haemostasis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Direct injection of N-butyl-2-cyanoacrylate

The correct answer is **A: direct N-butyl-2-cyanoacrylate injection**. This is an actively bleeding cardiofundal gastric varix (IGV1), for which cyanoacrylate injection is an established first-line endoscopic haemostatic treatment in current UK and European guidance. Fundal varices are large, lie deep in the submucosa and have high blood flow, making conventional band ligation less reliable than it is for oesophageal varices or GOV1. EUS-guided coil therapy is evolving, usually incorporates tissue adhesive and is not established as coil-only emergency treatment. Ethanolamine injection has inferior supporting evidence for fundal varices, while APC is a superficial thermal treatment and is unsuitable for a large variceal channel. Failure of endoscopic haemostasis should prompt urgent consideration of interventional radiological treatment, including TIPSS or retrograde transvenous obliteration where anatomically appropriate.

Reference: British Society of Gastroenterology, BSG position statement on risk stratification and management of portal hypertension and varices in cirrhosis, section 'Management of initial and recurrent bleeding', 2026. https://www.bsg.org.uk/getmedia/a45c14c0-6060-4b58-a729-6a388193a068/flgastro-2026-103698.pdf