The left gastric vein (coronary vein) is the most important portal-systemic collateral pathway. In portal hypertension it reverses flow — portal blood refluxes through the coronary vein to the oesophageal veins and azygos system, producing the submucosal oesophageal varices that rupture to cause variceal haemorrhage. Endoscopic variceal banding targets the oesophageal end of this collateral.
| Origin | Drains the lesser gastric curvature and distal oesophagus |
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Oesophageal variceal haemorrhage is one of the most common causes of death in cirrhosis. Emergency management: terlipressin (reduces portal pressure), endoscopic variceal banding or injection sclerotherapy, Sengstaken-Blakemore tube for refractory bleeding. TIPS reduces portal pressure for secondary prophylaxis. Beta-blockers (propranolol, nadolol) and endoscopic banding prevent first bleed in high-risk patients.
Left gastric vein retrograde flow producing oesophageal varices in portal hypertension — emergency management with vasoactive drugs, endoscopic banding, and TIPS for refractory cases.
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