Sclerotherapy of a Bleeding Duodenal Varix

Sauerbruch, Tilman; Weinzierl, M; Dietrich, H P; Antes, Günther; Eisenburg, J; Paumgartner, Gustav

doi:10.1055/s-2007-1021618

Cited by 51 publications

(21 citation statements)

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“…Duodenal varices may be more likely to apear when esophageal varices have been eradicated by sclerotherapy [61,62]. Erradication of one site of varices results in new portosystemic collaterals if the portal venous system is not decompressed.…”

Section: Duodenal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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Section: Duodenal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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“…Endoscopic therapy for bleeding duodenal varices emerged with sclerotherapy in the early 1980's [8] and EVL in the mid 1990's [9] . Since then, there have been only a handful of endoscopically managed duodenal variceal bleeds caused by extrahepatic portal hypertension (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

Steevens

Abdalla

Kothari

et al. 2015

WJGPT

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Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

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“…Management of variceal bleeding from IGV2 is often difficult [24, 25, 26, 27]. A high incidence of suspicion is needed to identify the source of variceal bleeding as IGV2 [1, 3, 28].…”

Section: Discussionmentioning

confidence: 99%

Isolated Gastric Varices: Prevalence, Clinical Relevance and Natural History

et al. 2003

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Background: Isolated ectopic gastric varices (IGV2) are present either in the body or antrum of the stomach or upper duodenum. The prevalence, natural history and clinical significance of these varices has not been adequately described. Materials and Methods: Consecutive patients with portal hypertension, prospectively studied and diagnosed to have IGV2, were assessed for their time of appearance – primary (at first presentation) or secondary (after obliteration of oesophageal varices), association with other varices, portal hypertensive gastropathy and any overt bleeding. Results: Fifty-three of the 1,128 (4.7%) patients had IGV2. The IGV2 were commonly seen in the antrum (53%), duodenum (32%), or at both sites (11%) and rarely in body and fundus (4%). IGV2 were predominantly (84.9%) secondary in origin, developing after oesophageal variceal obliteration. The median time for emergence of secondary IGV2 was 8.2 months for patients with cirrhosis, 12.8 months for non-cirrhotic portal fibrosis and 10.8 months for extra-hepatic portal vein obstruction. Eight (15%) patients had primary IGV2, 6 of them had underlying portal vein obstruction. Portal gastropathy (p < 0.05) and UGI bleeding were more common in the secondary than in primary IGV2. Bleeding due to IGV2 was seen only in 3 (5.7%) patients during a mean follow-up of 36.3 ± 12.1 months, and could be successfully managed with endoscopic ligation or obliteration. Conclusions: Isolated ectopic gastric varices are not uncommon and generally develop following obliteration of main variceal columns. They rarely bleed and often can be managed with endoscopic interventions.

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Sclerotherapy of a Bleeding Duodenal Varix

Cited by 51 publications

References 0 publications

Extraesophageal Varices

Extraesophageal Varices

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

Isolated Gastric Varices: Prevalence, Clinical Relevance and Natural History

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