Clinical Characteristics and Treatment for Patients Presenting With Bleeding Duodenal Varices

Kakizaki, Satoru; Toyoda, Mitsuo; Ichikawa, Takeshi; Sato, Ken; Takagi, Hitoshi; Arai, Hajime; Sohara, Naondo; Iizuka, Haruhisa; Onozato, Yoshikuni; Mori, Masatomo

doi:10.1111/j.1443-1661.2010.01007.x

Cited by 19 publications

(12 citation statements)

References 15 publications

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“…DV usually co-exist with varices in esophagus and stomach or the varices have been eradicated earlier and bleeding 1 st time from DV is very rare. [456789101112] Two of our patients presented 1 st time with bleed form DV.…”

Section: Discussionmentioning

confidence: 94%

“…As reported by earlier studies, all of our patients had DV located in the first part of duodenum. [4567891011121314]…”

Section: Discussionmentioning

confidence: 99%

“…However, the published experience on DV especially the role of EUS is limited. [456789101112] We retrospectively evaluated patients with DV seen at our institution over past 4 years and analyzed their clinical, endoscopic and EUS features as well as the outcome of treatment offered to them.…”

Section: Introductionmentioning

confidence: 99%

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Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

et al. 2014

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Background:Duodenal varices (DV) although an uncommon cause, are an important cause due to the severe nature of the bleed and associated adverse outcome.Materials and Methods:We retrospectively evaluated patients with DV seen at our institution over past 4 years.Results:A total of 10 patients (nine males; mean age was 35.8 ± 7.68 years) with DV were studied. Five patients had underlying cirrhosis and five had DV because of non-cirrhotic portal hypertension (four patients had extra-hepatic portal venous obstruction and one patient had non-cirrhotic portal fibrosis). Five patients presented with upper gastrointestinal (GI) bleed, whereas in the remaining five patients DV were detected on endoscopy performed for evaluation of portal hypertension. Endoscopy revealed submucosal lesion in nine patients, whereas in one patient an initial endoscopic diagnosis of Dieulafoy's lesion was made. However endoscopic ultrasound (EUS) could clearly identify DV in all patients. Of five patients presenting with upper GI bleed, three had the esophageal varices eradicated and two presented 1st time with bleed form DV and did not have esophagogastric varices. All patients with acute upper GI bleed were initially treated with intravenous terlipressin followed by glue (n-butyl cyanoacrylate) injection in 4/5 patients with one patient refusing further endoscopic therapy. The variceal obliteration was documented by EUS in all these four patients and there has been no recurrence of bleed in these four patients over a follow-up period of 4-46 months. The five non-bleeding DV were already on beta- blockers and the same were continued. Two of these five patients succumbed to progressive liver failure with none of these five patients having GI bleed on follow-up.Conclusion:EUS is a useful investigational modality for evaluating patients with DV and endoscopic injection of glue is an effective therapy for controlling and preventing recurrence of bleed from DV.

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Section: Discussionmentioning

confidence: 94%

“…As reported by earlier studies, all of our patients had DV located in the first part of duodenum. [4567891011121314]…”

Section: Discussionmentioning

confidence: 99%

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Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

et al. 2014

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“…48 In the current case series three patients had EHPVO and DV in bulb and D1 whereas four patients had cirrhosis and DV mainly in D2, an observation similar to other studies. 49 One patient had unusual varices extending from antrum to D2. One of the three patients with EHPVO had outgoing perforators going toward liver hilum.…”

Section: Discussionmentioning

confidence: 99%

Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

Sharma

Mohan

Rameshbabu

et al. 2012

Journal of Clinical and Experimental Hepatology

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Background/Aims: Duodenal varices (DV) are ectopic varices which can cause massive gastrointestinal bleeding. The diagnosis of DV may be difficult; sometimes they can be hidden behind duodenal folds. The aim of the study was to evaluate DV by endoscopic ultrasound. Methods: Endoscopic ultrasound was done in patients detected or suspected to be having DV. The para duodenal varices were identified and subsequently hemodynamic evaluation of DV was done. Results: Endoscopic ultrasound identified perforators in seven cases of DV. Conclusion: The endoscopic ultrasound can help in detection of DV underlying thickened folds. It can also help in hemodynamic evaluation of DV. ( J CLIN EXP HEPATOL 2012;2:229-237)

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“…Treatment options include surgical procedures and endoscopic and endovascular treatments. 3 We report an upper gastrointestinal (GI) tract bleeding at a cirrhotic patient with missdiagnosed duodenal varices even after five upper GI tract endoscopic examinations.…”

Section: Introductionmentioning

confidence: 97%

Complete Eradication of Bleeding Duodenal Varices with Endoscopic Polydocanol Sclerotherapy

Temel

Aktas

Özgenel

et al. 2010

Euroasian Journal of Hepato-Gastroenterology

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Bleeding from duodenal varices is a rare complication of portal hypertension, occurring in only 0.4% of these patients and is often life-threatening because of the difficulty in diagnosis and treatment. Treatment options include surgical procedures and endoscopic and endovascular treatments. A 48-year-old female cirrhotic patient was admitted to our clinic with upper gastrointestinal (GI) tract bleeding. Endoscopic examination revealed nonbleeding Lm, Cb, RC (+), F3-F3-F2 esophageal and nodular-bleeding-oozing duodenal varices. Esophageal varices were eradicated with band ligation at two sessions. After one session of 2% polydocanol sclerotheraphy, no signs of bleeding were determined. Complete eradication was achieved after five sessions and 1 year apart from the initial treatment duodenal varices were eradicated. Although duodenal varices are rare, they are frequently fatal. There are limited data regarding optimal treatment. Successful treatment depends both on patient factors (hepatic synthetic function, comorbidities, size/location of the varices) and center expertise. Long-term eradication is variable and may depend on the cause and extensiveness of the ectopic varices.How to cite this articleTemel T, Aktas A, Ozgenel SM, Özakyol A. Complete Eradication of Bleeding Duodenal Varices with Endoscopic Polydocanol Sclerotherapy. Euroasian J Hepato-Gastroenterol 2016;6(2):176-178.

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Clinical Characteristics and Treatment for Patients Presenting With Bleeding Duodenal Varices

Abstract: Although endoscopic treatment is useful for initial hemostasis of hemorrhagic duodenal varices, the patients who underwent additional IVR after endoscopic treatment achieved good outcomes.

Cited by 19 publications

References 15 publications

Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

Complete Eradication of Bleeding Duodenal Varices with Endoscopic Polydocanol Sclerotherapy

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