Balloon-Occluded Retrograde Transvenous Obliteration of Jejunal Varices: A Case Report, Therapeutic Approach

Cho, Soo Buem; Choi, Young Ho; So, Young; Ahn, Dong-Won; Jeong, Joseph H.

doi:10.1007/s10620-015-3949-5

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Kitagawa et al [12] showed a patient with jejunal variceal after choledochojejunostomy treated with EVO with cyanoacrylate. In our case series, all bleeding was completely controlled using only endoscopic modalities without surgeries or radiologic interventions such as BRTO [13,14] or TIPS. [15] We accomplished excellent hemostasis by cyanoacrylate injections in 5 cases, endoscopic variceal ligation in 2 cases, and hemoclipping in 1 case.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Park

Cho²,

Jun³

et al. 2017

Medicine

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Rationale:Ectopic variceal bleeding is a rare (2–5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results.Patient concerns:We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years.Diagnoses:All patients were diagnosed with liver cirrhosis presenting melena or hematemesis.Interventions:All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case).Outcomes:Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case.Lessons:EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

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Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Park

Cho²,

Jun³

et al. 2017

Medicine

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“…Our initial search yielded 395 case reports of SIV in patients with cirrhosis, of which 76 (19.2%) reported SIV bleeding and were included for collation and analysis (9–20,21–30,31–40,41–50,51–60,61–78). Mean age was 52.4 years (range 40–68), 32 were women, and 44 were men.…”

Section: Resultsmentioning

confidence: 99%

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

et al. 2021

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INTRODUCTION: Esophageal varices are a well-characterized sequela of portal hypertension; however, less is known about varices arising in ectopic locations. We aimed to describe bleeding small intestine varices (SIV) in patients with cirrhosis and compare characteristics and outcomes to published case reports. METHODS: We performed an institutional chart review using billing codes and natural language processing between 2008 and 2019. Inclusion criteria were adult patients with cirrhosis and SIV verified by endoscopy, video capsule, or imaging. Patients with noncirrhotic portal hypertension and stomal varices were excluded. We examined demographic and clinical factors, characteristics of SIV, bleeding, intervention, and outcomes in our series and collated data from published cases identified during a literature review. RESULTS: We identified 71 patients with cirrhosis and SIV (18 bled). The literature search yielded 76 cases with bleeding SIV. Our series and published cases were matched for age, sex, liver disease etiology, and SIV location. Length of stay and transfusion requirements were similar. Aggregate initial treatments (number, hemostasis rate) included medical (n = 7, 57%), endoscopic (n = 48, 56%), interventional radiology (n = 31, 77%), and surgery (n = 8, 87%). Hospital and overall mortality rates were higher in our series (22% and 38%) compared with the published cases (5.3% and 18.4%), respectively (P = 0.02 and P = 0.07). DISCUSSION: A quarter of patients with cirrhosis and SIV experience bleeding, with high transfusion requirements, frequent need for secondary interventions, and high mortality. These findings highlight the need for a multidisciplinary approach and second-line therapeutic modalities in the timely management of bleeding SIV in cirrhosis.

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“…Compared to other sclerosants, cyanoacrylate causes less tissue injury [ 17 ]. Unlike gastric varices, jejunal varices are the result of dilatation of the proximal branches of the superior mesenteric vein [ 6 ] that are within a short distance from the intrahepatic portal vein, and a higher volume of sclerosant may increase the risk of embolism [ 18 ] and obstruction of portal venous flow. Similar to Kitagawa Sho et al [ 5 ], we used higher concentration of glue mixture (3.0 mL of cyanoacrylate and 0.5 mL lipiodol) than the usual concentration (ratio of cyanoacrylate to lipiodol, 1:1 or 1:1.6) with a 3.0 mL bolus of cyanoacrylate in the second attempt to shorten the polymerization time and to prevent leakage into the liver.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the anatomic location of jejunal varices compared with esophageal or gastric varices, jejunal varices bleeding is much more difficult to detect and manage [ 4 ]. Hence, successfully treatment has been rarely reported [ 5 , 6 , 7 , 8 ]. Although surgery is the first choice for managing active bleeding traditionally, it is invasive and risky, especially in patients with cirrhosis and poor hepatic function [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Lee

Huang

2018

Medicina

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Jejunal varices are a rare manifestation of portal hypertension, and they are associated with a high mortality and poor prognosis when bleeding occurs. A bleeding jejunal varix is much more challenging to diagnose and manage because of its anatomic location. Herein, we describe the case of a 62-year-old man with active jejunal variceal bleeding who presented with massive hematochezia and hypovolemic shock. He was treated successfully with a high volume and concentration of a glue mixture as endoscopic sclerotherapy using single-balloon enteroscopy in the intensive care unit. Enteroscopic sclerotherapy is an effective option for jejunal variceal bleeding.

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Balloon-Occluded Retrograde Transvenous Obliteration of Jejunal Varices: A Case Report, Therapeutic Approach

Cited by 5 publications

References 10 publications

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

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