Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases

Copelan, Alexander; Chehab, Monzer; Dixit, Purushottam; Cappell, Mitchell S.

doi:10.1016/s1665-2681(19)31277-3

Cited by 23 publications

(27 citation statements)

References 35 publications

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“…Also with respect to other malignancies, there was no indication that these were of aetiological importance. Further studies in this type of EctVB are required to further address the timing of TIPSS and whether alternative therapeutic approaches, in particular balloon‐occluded retrograde‐transvenous‐obliteration may be a preferable strategy …”

Section: Discussionsupporting

confidence: 88%

“…Pre-TIPSS placement PSG (mm Hg), median (IQR) 14 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 22 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 14 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Post-TIPSS placement PSG (mm Hg), median (IQR) 6 (4-7) 12 (7-16) 5 (4-7)…”

Section: Patients With E-pfte-covered Stents (N = 45)unclassified

“…Further studies in this type of EctVB are required to further address the timing of TIPSS and whether alternative therapeutic approaches, in particular balloon-occluded retrograde-transvenousobliteration may be a preferable strategy. 26 The efficacy of TIPSS has to be balanced against the risk of serious side effects, in particular HE. Post-TIPSS HE manifested or worsened in 30% of our patients, which was comparable with other reported experience.…”

Section: Patients With E-pfte-covered Stents (N = 45)mentioning

confidence: 99%

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Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study

Oey

Wit

Moelker

et al. 2018

Aliment Pharmacol Ther

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SummaryBackgroundEvidence for the efficacy of TIPSS in ectopic variceal bleeding (EctVB) is largely based on relatively small series.AimTo define the efficacy of TIPSS in EctVB.MethodsRetrospective analysis of consecutive patients with chronic liver disease who presented with EctVB and received TIPSS in three tertiary centres in 1992‐2016.ResultsThe study included 53 patients (70% male, median age 61 years, median model for end‐stage liver disease (MELD) score 11). The ectopic varices were located around the insertion of stomas (40%), duodenum (23%), rectum (17%) and at other sites (20%). Three‐quarters of the patients had previously received unsuccessful medical, endoscopic or surgical therapy. The median follow‐up was 14.0 months. Following TIPSS, bleeding recurred in 12 patients: 6 of 12 (50%) with duodenal varices, 2 of 9 (22%) with rectal varices and one each with stomal (1/21), intraperitoneal (1/3), hepaticojejunostomy (1/2) and ascending colon varices (1/2). The risk factors for re‐bleeding were MELD score at TIPSS placement (HR: 1.081 per point; 95% confidence interval (CI): 1.012‐1.153; P = 0.034), varices located at site other than an enterostomy (HR: 9.770; 95%CI: 1.241‐76.917; P = 0.030) and previous local therapy (HR: 5.710; 95%CI: 1.211‐26.922; P = 0.028). The estimated cumulative re‐bleeding rate was 23% at 1 year, 26% at 3 years and 32% at 5 years. Post‐TIPSS hepatic encephalopathy manifested or worsened in 16 of 53 patients (30%).Conclusion TIPSS provides long‐term control of bleeding in most cirrhotic patients with EctVB. TIPSS is particularly effective in stomal EctVB, the most frequent cause of EctVB, but might not be as effective in duodenal EctVB.

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Section: Discussionsupporting

confidence: 88%

Section: Patients With E-pfte-covered Stents (N = 45)unclassified

Section: Patients With E-pfte-covered Stents (N = 45)mentioning

confidence: 99%

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Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study

Oey

Wit

Moelker

et al. 2018

Aliment Pharmacol Ther

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“…[64][65][66] A recent systematic review that included 21 patients undergoing BRTO for bleeding DV showed excellent technical results with only 2 patients suffering early re-bleed. 67 Due to lack of randomized trials, a universal recommendation for the treatment of DV cannot be made, but the evidence noted here suggests that, similar to RV, IVO is a good treatment strategy for DV. If re-bleeding occurs following creation of an alternative outflow track (such as TIPS), then this may be a good point to consider endoscopic cyanoacrylate therapy to try to affect local control.…”

Section: Duodenal Varicesmentioning

confidence: 88%

Management of bleeding ectopic varices

Henry

Caldwell

2017

Techniques in Gastrointestinal Endoscopy

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“…[111][112][113] A recent systematic review including 21 patients undergoing BRTO for bleeding DVs showed excellent technical results, with only two patients having early rebleed. 114 It should be noted that the case series of both TIPS and BRTO for the management of DVs bleeding include a very heterogeneous group of vascular shunts and patient presentations, making any definitive recommendations for either therapy inappropriate. Ultimately, these cases should be approached in a multidisciplinary discussion between the managing hepatologist and the interventional radiologist to determine the best approach and should be based on local expertise and resources available at your institution.…”

Section: Duodenal Varicesmentioning

confidence: 99%

Management of Gastric and Ectopic Varices: The Endoscopist's Perspective

Henry

2020

Digestive Disease Interventions

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Gastric and Ectopic varices are a rare complication of portal hypertension and represent a complex, heterogeneous system of vascular shunts. Bleeding from these shunts can be severe and life-threatening, with poorly standardized treatment algorithms to follow in their management. When bleeding occurs, it is important to follow standard diagnostic procedures for portal hypertensive bleeding and always obtain imaging of the underlying vascular anatomy to help guide therapy. Potential treatment methods will depend on these imaging findings as well as the location of the varix within the gastrointestinal tract. While gastric varices have more data to support specific treatment options, duodenal and rectal varices have only case reports and case series to guide their care. In addition, stomal varices are a very rare complication of portal hypertension and have limited data to support any one treatment modality. Gastric and ectopic varices are best approached in a multidisciplinary fashion after discussion with hepatologists and interventional radiologists to overcome the uncertainty in choosing a definitive therapy.

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Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases

Cited by 23 publications

References 35 publications

Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study

Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study

Management of bleeding ectopic varices

Management of Gastric and Ectopic Varices: The Endoscopist's Perspective

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