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May 2, 1977

Gastric Varices Without Esophageal Varices: An Important Preendoscopic Diagnosis

Author Affiliations

From the departments of radiology (Drs Rice, Thompson, Kelvin, and Kriner) and internal medicine (Dr Garbutt), Duke University Medical Center, Durham, NC.

JAMA. 1977;237(18):1976-1979. doi:10.1001/jama.1977.03270450066030

THE ROENTGENOGRAPHIC demonstration of fundal gastric varices by the conventional upper gastrointestinal examination is notoriously difficult.1-3 Though it is generally believed that most patients with esophageal varices will also have gastric varices, the latter are rarely verified with the conventional upper gastrointestinal examination.2 The normal gastric rugae frequently have a rather coarse, beaded contour that effectively conceals the dilated veins in the wall of the fundus of the stomach.

Gastric fundal varices may assume either a localized polypoid configuration or produce multiple, rounded, submucosal projections throughout the gastric fundus.4 In either of these situations, the diagnosis of gastric varices may be suspected if the patient has evidence of portal hypertension or pancreatic disease. Doublecontrast examination of the stomach usually provides optimal delineation of polypoid masses in the fundus. Absolute roentgenographic diagnosis depends on opacification of the dilated veins by angiography or splenoportography.1,2,5

The possibility of gastric