Evaluation of Rectal Varices by Endoscopic Ultrasonography in Patients With Portal Hypertension

Abstract

The usefulness of endoscopic ultrasonography (EUS) in the evaluation of rectal varices (RV) was determined in 50 patients with portal hypertension (PH) and 25 PH-free controls. F1 and F2 varices and angiectasia were specific for the PH group as evaluated by endoscopy, but there was no difference between the PH and the control groups with respect to the frequency of blue vein. The detection rate of submucosal veins (SMV) with EUS was 88% for the PH group and 68% for the control group. The mean SMV diameter was significantly greater for the PH group than for the control group, and no 2-mm or larger SMV was detected in the control group. Serum albumin and cholinesterase levels were significantly higher for the RV(+) patients with SMV 2mm or more in diameter in the PH group than for the RV(–) patients. The spleen index was also significantly higher for the former group. The frequency of RV was significantly higher for advanced PH than for mild PH. RV(+) was detected in about 30% of endoscopically normal patients in the PH group. The results of this study indicate that EUS is useful in detecting RV and evaluating its pathological condition.

Prevalence of ‘deep’ rectal varices in patients with cirrhosis: an EUS‐based study

“…We found the prevalence of these features within the ranges already reported in the literature. For example, the prevalence of blue veins in our study was 38% as compared with 36% found by Kobayashi (6).…”

“…Colonic changes in cirrhosis have been investigated in numerous studies. They were described by many terms that included vascular ectasias, vascular lesions, colitis‐like abnormalities, red spots, dendriform vasodilatations, angiodysplastic‐like lesions, redness, blue veins, spider angiomas, hyperaemia and varices (3, 5, 6, 8, 9). Considering this plethora of terms, not surprisingly, the prevalence of portal hypertensive colopathy has been reported to occur between 17 and 70% of patients, with portal hypertension and normal colon described between 9 and 42% of cirrhotics (1, 10).…”

“…Haemorrhoids are localized to the submucosa of the anal canal, do not communicate with portal circulation and show no increased prevalence in patients with portal hypertension (11, 12). On the other hand, rectal varices are collaterals that arise as a consequence of portal hypertension and serve to decrease portal pressure (6, 13). The prevalence of rectal varices has been reported in 3.6–63% of patients with liver cirrhosis (1, 2).…”

“…The following features related to portal colopathy were recorded: congestive rectopathy, blue veins and varices. Blue veins were defined as slightly elevated blue‐tinted vessels that are flat but come into view after air insufflation as described by Ito et al and Kobayashi (5, 6). Rectal varices were defined as significantly distended veins emerging from the rectal wall, localized clearly above the anal margin.…”

Massive lower GI bleed from an endoscopically inevident rectal varices: diagnosis and management by EUS (with )

“…As portal hypertension tends to persist, it seemed logical to offer partial therapy for EIE-RVs. 17,18 This case also shows that rectogenital communication exists in portal hypertension and represents dilatation of preexisting embryonic vascular channels. 19,20 In the available literature, only one case report of major bleeding from EIE-RVs has been described that was managed by RIP.…”