Gastric varices secondary to splenic vein occlusion: endoscopic color Doppler ultrasonography aids diagnosis

Sato, Takahiro

doi:10.1007/s10396-012-0365-8

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…In particular, it is difficult to distinguish between gastric varices and gastric folds in the condition of left-sided portal hypertension. Sato [5] discussed the value of ECDUS in patients with gastric varices secondary to splenic occlusion.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

GOA

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A 71-year-old woman was admitted to our hospital for treatment of cancer in the body and tail of the pancreas. After admission, she had tarry stool and esophagogastroduodenoscopy (EGD) was performed. EGD revealed enlarged tortuous, red color sign negative gastric varices between the cardiac orifice, fundus and the curvature ventriculi major of the gastric body.Computed tomography showed gastric varices due to splenic vein occlusion with advanced pancreatic cancer (left-sided portal hypertension).However, endoscopic observation was not sufficient to identify the bleeding site of the gastric varices.Consecutively, endoscopic color Doppler ultrasonography (ECDUS) was performed to evaluate the gastric varices in detail.ECDUS showed the velocity of gastric varices in the cardiac orifice and fundus to be 11.7 cm/sec, the thickness of the gastric wall to the submucosal gastric varices being 1.0 mm, and the gastric varices in the cardiac orifice and fundus were diagnosed as the likely bleeding site. Subsequently, we performed endoscopic obliterative therapy with 70% n-butyl-2-cyanoacrylate diluted with 5% Lipiodol at the possible bleeding site of these varices. The patient experienced no further episodes of bleeding during the three months following treatment.

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Section: Discussionmentioning

confidence: 99%

Untitled

2017

GOA

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“…These data provide specific findings that can function as hallmarks of gastric varices due to splenic vein occlusion. The sensitivity of ECDUS in identifying gastric varices due to splenic vein occlusion should be considered for patients with high clinical suspicion [33]. Percutaneous ultrasonographic examinations and color flow imaging are used as a preliminary, non-invasive method for splenic vein occlusion.…”

Section: Diagnosis Of Gastric Varices Secondary To Left-sided Portal mentioning

confidence: 99%

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Kimura¹

2013

Pancreat Disord Ther

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Sato et al., Pancreatic Dis Ther 2013, S3 http://dx.doi.org/10.4172/2165 Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases Takahiro Sato*, Sho Kitagawa, Mutsuumi Kimura, Takumi Ohmura, Yoshiyasu Karino and Jouji Toyota Department of Gastroenterology, Sapporo Kosei General Hospital, Japan occlusion because of the splenic vein, s anatomy. Sutton et al. reported that 35% of their cases of isolated splenic vein occlusion were caused by tumors and only 17% by pancreatitis [9]. On the other hand, Sakorafas et al. found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]. There is a possible pathogenetic mechanism implying the increased intra-abdominal pressure leading to compression of the splenic vein in the case of pancreatic pseudocyst [19,20].Due to splenic vein occlusion, splenic venous flow must drain into collateral veins (short gastric vein and left gastroepiploic vein). Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.Although splenic vein occlusion is commonly silent clinically, AbstractGastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches.Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body.Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the sp...

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“…Additional images resulting from ECDUS color analysis of gastric variceal flow clearly depicted a round fundal region at the center, with varices that expanded to the curvatura ventriculi major of the gastric body [65] (Figure 5). …”

Section: Gastric Varices Secondary To Splenic Vein Occlusionmentioning

confidence: 99%

Endoscopic Color Doppler Ultrasonography for Esophagogastric Varices

Sato

Yamazaki

2012

Diagnostic and Therapeutic Endoscopy

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Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Endoscopic ultrasonography not only visualizes the surface of the varices but also provides detailed information about their internal structure. The direction of blood flow can be determined and its velocity measured only via endoscopic color Doppler ultrasonography (ECDUS). This can show graphically esophageal varices, paraesophageal veins, and passageways in esophageal variceal patients and gastric varices, perigastric collateral veins in gastric variceal patients. It is important to evaluate the hemodynamics of the portal venous system when treating the esophago-gastric varices. ECDUS is a useful modality for the evaluation of the detailed hemodynamics and the therapeutic effects of esophago-gastric varices.

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Gastric varices secondary to splenic vein occlusion: endoscopic color Doppler ultrasonography aids diagnosis

Cited by 3 publications

References 5 publications

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Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Endoscopic Color Doppler Ultrasonography for Esophagogastric Varices

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