Current approaches for management of gastric varices in the United States: a survey of providers’ attitudes and practices

Introduction: Bleeding from gastric varices (GV) is more drastic and associated with higher mortality than that from esophageal varices. There are multiple therapeutic approaches for GV bleeding. Although endoscopic cyanoacrylate glue injection (ECGI) is recommended as the first-line management for GV bleeding worldwide, its implementation in the US is limited. We conducted a survey among health care providers to examine attitudes and practice related to GV management. Methods: Collected data were cleaned using SPSS V24. Summary statistics and graphical analyses for continuous and categorical variables were used to describe the data. Continuous variables with a normal distribution are presented as mean ± standard deviation. Results: A total of 339 providers completed the survey, for a response rate of 16.95%. Nearly a quarter of respondents reported performing ECGI in patients with GV bleeding. Male healthcare providers (odds ratio [OR]: 2.1, 95% confidence interval [CI] = 1.22-3.75, P = 0.006), transplant hepatologists (OR: 2.6, 95% CI = 1.25-4.87, P = 0.019), and those working in hospitals with liver transplantation centers (OR: 2.5, 95% CI = 1.35-4.62, P = 0.002) were more likely to perform ECGI in GV bleeding cases. However, only gender was significant in the multivariate model. Conclusions: Our results indicate the underutilization of ECGI in GV patients among US endoscopists. Key hurdles are lack of training and approval from the US Food and Drug Administration.