Gastric varices: pathophysiology, treatment, and prevention. Gastric varices are a rare form of extrahepatic portal hypertension (EHPH). Gastrointestinal hemorrhage from gastric varices is a relatively common clinical condition. Portal hypertension has a causative role and can be manifested as variceal or nonvariceal bleeding. We review the pathophysiology, clinical features, management, and prevention of gastric varices. This report is based on review of the English literature. Bleeding from gastric varices can be the initial symptom of EHPH. Although a detailed analysis of the cause of bleeding was not available in any of the reports included in our review, the most common cause is liver cirrhosis, particularly liver cirrhosis resulting from hepatitis C virus infection. In addition to surgery, bleeding from gastric varices can be treated by endoscopic sclerotherapy and band ligation; however, most procedures fail to achieve hemostasis. Endoscopic obliteration of the bleeding vessel is achieved through injection sclerotherapy with cyanoacrylate (glue), coil embolization, or, less commonly, band ligation. In addition to surgery, endoscopic sclerotherapy with injection sclerotherapy with cyanoacrylate is the most widely used method for treatment of gastric varices. However, no definitive method has yet been determined. Endoscopic treatment has many complications, including perforation, bleeding after initial hemostasis, portal vein thrombosis, sepsis, rebleeding, and so on. EHPH is common in the elderly. The first choice for hemostasis is endoscopic treatment. However, this should be performed only in facilities with experience in endoscopic treatment. If endoscopic treatment fails, the most important measure is an operation. In the future, noninvasive methods for treating gastric varices should be established.