Successful Therapy of Bleeding Duodenal Varices by Tips After Failure of Sclerotherapy

Jonnalagadda, Sreenivasa S.; Quiason, Stella G.; Smith, Owen J.

doi:10.1111/j.1572-0241.1998.270_3.x

Cited by 68 publications

(47 citation statements)

References 3 publications

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“…Patients with bleeding varices that are inaccessible to an endoscope or respond poorly to sclerotherapy are well suited to TIPS. Typical cases include fundal varices, small bowel varices (classically around anastomotic or surgical resection sites [98,99] intraabdominal varices (punctured during large volume paracentesis [100] , stomal varices [101,102] (usually in patients with inflammatory bowel disease and sclerosing cholangitis), and bleeding rectal varices [103] . These sites are also amenable to embolization via shunt.…”

Section: Emergency Transhepatic Porto-systemic Stent Shuntmentioning

confidence: 99%

Acute variceal bleeding: general management

Patch

Dagher²

2001

WJG

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Section: Emergency Transhepatic Porto-systemic Stent Shuntmentioning

confidence: 99%

Acute variceal bleeding: general management

Patch

Dagher²

2001

WJG

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“…[24][25][26][27][28][29] In the largest series to date, nine patients with intestinal varices received TIPS. 26 Five of these patients were Child-Pugh class C at the time that the procedure was performed.…”

Section: Management Of Bleeding Ectopic Varicesmentioning

confidence: 99%

Management of ectopic varices

1998

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The term ''ectopic varices'' is sometimes reserved for abnormally dilated veins associated with gastrointestinal mucosa and, therefore, with the potential for gastrointestinal hemorrhage. However, the term has also been used loosely to describe portosystemic collateral veins in the abdominal wall and retroperitoneum. The distinction between ''ectopic varices'' and collaterals that are commonly found on the abdominal wall and retroperitoneum of patients with portal hypertension is one of semantics. Thus, ectopic varices may be best defined as large portosystemic venous collaterals occurring anywhere in the abdomen except in the cardioesophageal region.Ectopic varices are an unusual cause of gastrointestinal hemorrhage, but account for up to 5% of all variceal bleeding. 1 The clinician caring for patients with gastrointestinal bleeding must be aware of this entity, because diagnosis and management of ectopic varices differ from that of esophagogastric varices. Furthermore, the prognosis from bleeding ectopic varices may be poor, with one study quoting 40% mortality at initial bleed from duodenal varices. 2 The literature on this subject consists mainly of small series and case reports with no randomized trials of therapeutic modalities. However, a review of the literature does provide sufficient information from which rational management decisions can be made. PREVALENCEEctopic varices account for between 1% and 5% of all variceal bleeding. 1,3 Ectopic varices are a relatively common finding at endoscopy in patients with portal hypertension. The prevalence seems to be related to the cause of the portal hypertension and the technique used to show the varices. In patients with intrahepatic portal hypertension, duodenal varices are seen in 40% of patients undergoing angiography, 3 whereas anorectal varices have been reported in between 10% and 40% of cirrhotic patients undergoing colonoscopy. 4,5 It is important to differentiate anal varices from hemorrhoids: Anal varices collapse with digital pressure, whereas hemorrhoids do not. 4 In patients with portal hypertension caused by obstruction of the portal or splenic veins, duodenal varices are more prevalent than in patients with intrahepatic portal hypertension. The prevalence is higher if angiography is used to show varices. In fact, most patients with portal or splenic vein thrombosis are likely to have duodenal varices shown on angiography. 6,7 The majority of patients with duodenal varices visualized on endoscopy have extrahepatic portal hypertension. In contrast to duodenal varices, it appears that most cases of varices in other portions of the small intestine and colonic varices are seen in patients with intrahepatic portal hypertension who have previously undergone abdominal surgery. 6 In the west, because the prevalence of extrahepatic portal hypertension is low, most bleeding from ectopic varices is usually associated with intrahepatic portal hypertension. 6,8 Stomal varices are a particularly common cause of ectopic varices and occur in patients with intrah...

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“…We tried to do an endoscopic ligature in one case, but with poor results. The treatment options with interventional radiology are percutaneous transhepatic obliteration (PTO), transileocolic vein obliteration (TIO), balloon-occluded retrograde transvenous obliteration (B-RTO) and transjugular intrahepatic portosystemic shunt (TIPS) (8,11). Treatment with TIPS reduces the incidence of the rebleeding, but it increases postoperative mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of duodenal varices with cyanoacrylate

Mora-Soler

Velasco-Guardado

Acosta-Materán

et al. 2013

Rev. esp. enferm. dig.

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Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control.Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding.Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.

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Successful Therapy of Bleeding Duodenal Varices by Tips After Failure of Sclerotherapy

Cited by 68 publications

References 3 publications

Acute variceal bleeding: general management

Acute variceal bleeding: general management

Management of ectopic varices

Endoscopic treatment of duodenal varices with cyanoacrylate

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