Downhill Esophageal Varices: A Therapeutic Dilemma

Chakinala, Raja Chandra; Kumar, Arun; Barsa, Jonathan E.; Mehta, Dhruv; Haq, Khwaja F.; Solanki, Shantanu; Tewari, V.K.

doi:10.14309/00000434-201810001-01756

Cited by 5 publications

(16 citation statements)

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“…When there is obstruction of the SVC, venous flow makes its way back to the right atrium via collateral pathways to the inferior vena cava. One collateral pathway it can take is through the azygos and hemiazygos veins that then flow into the esophageal venous plexus, thus creating DEV [1,2]. When the SVC obstruction is above the azygos vein, varices form in the upper third of the esophagus, whereas if obstruction is at the level of or below the azygos vein, varices form throughout the entire esophagus [1].…”

Section: Introductionmentioning

confidence: 99%

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Hematemesis, a Rare Presentation for Downhill Esophageal Varices

Van

Singh

2021

Case Rep Gastroenterol

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Downhill esophageal varices (DEV) are a rare form of esophageal varices associated with superior vena cava obstruction. Obstruction leads to retrograde blood flow through collateral venous channels, including the esophageal venous plexus, to redirect blood flow to the right atrium via the inferior vena cava. This leads to the formation of DEV. It is a rare phenomenon to have gastrointestinal bleeding, especially hematemesis, on a patient’s first presentation with this disease process. We describe such a case here involving a patient with DEV secondary to metastatic renal cell carcinoma presenting with hematemesis.

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Section: Introductionmentioning

confidence: 99%

“…Less than 0.1% of patients present with hematemesis [5,6]. Those who have a long-term venous catheter complicated by SVC narrowing, due to endothelial injury or thrombosis, make up the population with the highest DEV bleeding risk (around 27%) [1,7]. Only 14% of DEV cases secondary to malignancy are complicated by bleeding [1,7].…”

Section: Introductionmentioning

confidence: 99%

Hematemesis, a Rare Presentation for Downhill Esophageal Varices

Van

Singh

2021

Case Rep Gastroenterol

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“…Advanced cirrhosis often presents many complications, such as portosystemic collateral vessels, variceal bleeding, ascites, and hepatic encephalopathy (HE) (1). Esophageal varices (EVs) are the most common collateral vessels secondary to portal hypertension in cirrhotic patients and often develop at a rate of 7% per year (2). Acute gastrointestinal bleeding (GIB) caused by variceal rupture in cirrhotic patients is life-threatening with a high 6-week mortality of 15-25% (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Esophageal varices (EVs) are the most common collateral vessels secondary to portal hypertension in cirrhotic patients and often develop at a rate of 7% per year (2). Acute gastrointestinal bleeding (GIB) caused by variceal rupture in cirrhotic patients is life-threatening with a high 6-week mortality of 15-25% (1,2). Considering that endoscopy is often invasive and less available in some remote areas, our previous multicenter observational study conducted in Liaoning province, China established Liaoning score for non-invasively predicting EVs (3), which were based on some simple variables, and found that Liaoning score had a better performance in diagnosing EVs as compared to several other non-invasive scores in patients who had never undergone endoscopy.…”

Section: Introductionmentioning

confidence: 99%

External validation of Liaoning score for predicting esophageal varices in liver cirrhosis: a Chinese multicenter cross-sectional study

Zhu

et al. 2019

Ann Transl Med

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Background: Our previous study developed Liaoning score as a non-invasive approach for predicting esophageal varices (EVs) in liver cirrhosis. This nationwide multicenter cross-sectional study aimed to externally validate the diagnostic accuracy of Liaoning score and further evaluate its performance for predicting high-risk EVs.Methods: Cirrhotic patients with acute gastrointestinal bleeding (GIB) without history of endoscopic variceal therapy who underwent endoscopic examinations at their admissions were included. Liaoning score and several non-invasive liver fibrosis scores, including aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase ratio (AAR), fibrosis 4 index (FIB-4), King, and Lok scores, were evaluated. Area under curves (AUCs), cut-off value, sensitivity, and specificity were calculated.Results: Overall, 612 patients were included. The prevalence of EVs and high-risk EVs was 96.2% and 95.6%, respectively. In overall patients, the AUCs of Liaoning score for predicting EVs and high-risk EVs were higher than non-invasive liver fibrosis scores (0.737 versus 0.626-0.721; 0.734 versus 0.611-0.719).The cut-off value of Liaoning score for high-risk EVs was 0.477 with a sensitivity of 81.96% and a specificity of 65.22%. In patients with hematemesis, Liaoning score could significantly predict EVs and high-risk EVs (AUCs =0.708 and 0.702, respectively), but not non-invasive liver fibrosis scores. The cut-off value of Liaoning score for high-risk EVs was 0.437 with a sensitivity of 83.16% and a specificity of 60%.Conclusions: Liaoning score should be a non-invasive alternative for predicting EVs and high-risk EVs in cirrhotic patients with acute GIB.

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“…For this reason, current guidelines recommend that all cirrhotic patients should be screened for gastroesophageal varices 1,3,4 . Esophagogastroduodenoscopy is considered the reference standard technique for the diagnosis of esophageal varices, allowing their direct visualization, assessment of severity, and risk stratification for rupture, and for its interventional capabilities 5 . Endoscopy, however, is an invasive procedure with possible complications, such as perforation.…”

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confidence: 99%

Color Doppler Ultrasound in Portal Hypertension

Cannella¹,

Giambelluca

Pellegrinelli

et al. 2020

J of Ultrasound Medicine

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Portal hypertension is one of the most important causes of morbidity and mortality in cirrhotic patients. A color Doppler evaluation of the left gastric vein (LGV) has proven utility in the prediction of esophageal varices and variceal bleeding in patients with portal hypertension. The purpose of this review is to discuss the ultrasound evaluation, imaging findings, and clinical application of Doppler ultrasound in the assessment of the LGV. Knowledge of the color Doppler technique and imaging findings of the LGV may help clinicians improve the monitoring of portal hypertension and predict patients with a high risk of esophageal varices.

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Downhill Esophageal Varices: A Therapeutic Dilemma

Cited by 5 publications

References 0 publications

Hematemesis, a Rare Presentation for Downhill Esophageal Varices

Hematemesis, a Rare Presentation for Downhill Esophageal Varices

External validation of Liaoning score for predicting esophageal varices in liver cirrhosis: a Chinese multicenter cross-sectional study

Color Doppler Ultrasound in Portal Hypertension

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