Duodenal varices successfully treated with cyanoacrylate injection therapy

Malik, Ahsan; Junglee, Naushad A.; Khan, Anwar; Sutton, Jonathon; Gasem, Jaber; Ahmed, Waqar

doi:10.1136/bcr.02.2011.3913

Cited by 14 publications

(16 citation statements)

References 19 publications

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“…We saw obturation of varices in 3 of 5 cases; the rest were unavailable. In concordance with other reported cases, [9,11,16] cyanoacrylate injection seems to be effective and safe without serious adverse events.…”

Section: Discussionsupporting

confidence: 91%

“…Akazawa et al [8] showed successful management of duodenal variceal bleeding by EVL and subsequent BRTO. Malik et al [9] and Mora-Soler et al [10] reported 1 and 5 patients with duodenal variceal bleeding treated successfully with cyanoacrylate injection, respectively. Schmeltzer et al [11] presented a case of duodenal variceal bleeding successfully treated with EVL.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 91%

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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“…Currently it is advocated to start vasoactive medication and to try endoscopic measures if technically feasible, with band ligation for small varices only (due to the risk of a large mucosal defect) and cyanoacrylate injection being the most consensual 4 11–13. There are reports on alternative endoscopic techniques like human thrombin injection5 6 that may be less likely to cause thromboembolic complications 14.…”

Section: Discussionmentioning

confidence: 99%

“…Case reports and case series include medical treatment with vasoactive drugs, elastic band ligation, cyanoacrylate4 and human thrombin injection5 6 as endoscopic modalities, transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) by means of interventional radiology and, finally, performing a surgical shunt 3…”

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal bleeding in cirrhosis: varix or no varix?

Ferreira¹,

Sousa

Brito

et al. 2013

BMJ Case Reports

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SUMMARYUpper gastrointestinal bleeding from variceal origin is a frequent complication in the cirrhotic population. Duodenal variceal haemorrhage, however, is infrequent and the endoscopic management of such lesions is not straightforward. Non-endoscopic options include vasoactive drugs, transjugular intrahepatic portosystemic shunt (TIPS), transvenous obliteration and surgery as rescue therapy. We present a patient with Child-Pugh A hepatitis C virus-cirrhosis with acute bleeding from a duodenal varix. It was managed with elastic band ligation but late rebleeding occurred after 6 weeks. Gastroduodenoscopy revealed active bleeding from the ligation eschar. Band ligation and sclerosis were attempted but unsuccessful. Terlipressin was started and the patient referred for TIPS. Surprisingly, angiography showed a normal hepatic vein pressure gradient; therefore, TIPS was not performed. Haemorrhage ceased with medical treatment alone. The patient remained stable and was discharged after 10 days, being currently under evaluation for hepatitis C therapy. BACKGROUND

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“…1 Although a rare cause of gastrointestinal (GI) bleeding, they are reported to have a high mortality, around 40%. [1][2][3][4][5][6][7] Up to 17% of ectopic varices occur in the duodenum, 3 4 but they are not a common cause of variceal bleeding.…”

Section: Introductionmentioning

confidence: 99%

Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make

Bhagani

Winters

Moreea³

2017

BMJ Case Reports

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We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.

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Duodenal varices successfully treated with cyanoacrylate injection therapy

Cited by 14 publications

References 19 publications

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Upper gastrointestinal bleeding in cirrhosis: varix or no varix?

Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make

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