Practice Patterns for the Management of Gastric Varices: An International Survey

Thank you for taking time to participate in this study. We hope to delineate practice patterns in the management of gastric varices internationally. The survey contains 34 questions, which take less than 5 minutes to complete. 

Lolwa Al-Obaid MD, Mohammad Bilal MD, Katarzyna Pawlak MD PhD, Nadeem Tehami MD, Diogo Moura MD PhD, Rashid Liu MD, Jayanta Samanta MD, Aymen Almuhaideb MD, Andrés Rodríguez Parra MD, Andrés Cardénas MD PhD, Marvin Ryou MD, Ahmad Najdat Bazarbashi MD. 
Sarin Classification, for reference only.
Sarin Classification, for reference purposes.
1.What type of practitioner are you?
2.What is your subspecialty?
3.How many years have you been performing endoscopies?
4.How many direct endoscopic injections of gastric varices have you done?
5.How many years of EUS experience do you have?
6.How many EUS guided injections of gastric varices have you done?
7.What region do you practice in?
8.Please enter the country you practice in.
9.What hospital setting do you practice in?
10.What is the level of care at the hospital you practice in?
11.What sector of healthcare do you work in?
12.Is your hospital a liver transplant center?
13.Does your hospital have interventional radiology capabilities?
14.For patients with gastric varices, which of the following do you recommend for primary prevention of GV bleeding?  [select all that applies]
15.Do you routinely get cross sectional imaging in a patient with suspected acute gastric variceal bleeding?
16.Does your hospital routinely use vasoactive medications (e.g. Octreotide, Somatostatin, Terlipressin) for gastric variceal bleed patients?
17.Do you arrange for Hepatic Venous Pressure Gradient (HVPG) or EUS-guided portal pressure gradient measurements prior to endoscopic therapy for gastric varices?
18.A patient with portal hypertension presents with acute gastrointestinal bleeding. After initial stabilisation, an endoscopy is performed confirming isolated bleeding gastric varices (IGV-1), which of the following do you pursue in your practice?
19.A patient with pancreas cancer and splenic vein thrombosis presents with acute gastrointestinal bleeding. After initial stabilisation, an endoscopy is performed confirming isolated bleeding gastric varices (IGV-1). Which of the following do you pursue in your practice?
20.What is your choice of first-line endoscopic treatment in bleeding GOV1?
21.What is your choice of first-line endoscopic treatment in bleeding IGV1/GOV2?
22.What is your cyanoacrylate glue option of choice for GV treatment?
23.In patients managed with EUS-guided coil therapy, which of the following do you use?
24.What needle size do you use when performing EUS-guided coil therapy?
25.In patients treated with EUS-guided coil therapy, how many coils do you aim to deploy?
26.If glue injection is deemed necessary, how much glue do you aim to inject following coil placement?
27.For patients treated with endoscopic glue injection, when do you perform/recommend repeat endoscopy?
28.For patients treated with EUS-guided coil therapy, when do you perform/ recommend repeat endoscopy and/or EUS?
29.In patients treated with direct endoscopic injection or EUS-guided coils (with or without glue), do you obtain post procedure cross sectional imaging of the chest and or abdomen?
30.Which of the following do you recommend for a patient with recurrent gastric variceal bleeding after initial endoscopic glue injection therapy?
31.Do you use non-selective B-blocker as part of your management plan in secondary prophylaxis (after index GV bleed)?
32.Which of the following do you recommend for a patient with recurrent gastric variceal bleeding after initial EUS guided coil injection therapy?
33.If you have been doing EUS-guided therapy of gastric varices, what do you think is the learning curve for such procedure?
34.What society do you follow for the management of gastric varices?