1 Recommendations

Guidance

1.1 Evidence on the safety and efficacy of transvenous obliteration of gastric varices is adequate in the short term but limited in the long term. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do transvenous obliteration of gastric varices should:

Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. This should include the risk of:
- balloon rupture and embolisation of sclerosant or device during the procedure
- an increase in portal vein pressure in the long term, which may exacerbate ascites and oesophageal varices.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Enter details about everyone having transvenous obliteration of gastric varices onto suitable registry databases where available and review local clinical outcomes.
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Patient selection should be discussed with a specialist centre that offers all of the standard treatments for portal hypertension and bleeding gastric varices, and that is experienced in managing acute and chronic liver disease.

1.5 The procedure should only be done by clinicians with training in and experience of the procedure.