Therapeutic strategy for patients with bleeding rectal varices complicating liver cirrhosis

Yoshino, Kiyoko; Imai, Yumiko; Nakazawa, Masatoshi; Chikayama, Taku; Ando, Satsuki; Sugawara, Kayoko; Hamaoka, Kazuhiro; Inao, Mie; Oka, Masashi; Mochida, Satoshi

doi:10.1111/hepr.12232

Cited by 21 publications

(20 citation statements)

References 20 publications

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“…The most common cause of rectal varices is portal hypertension due to liver cirrhosis, which is present in 3.6-78% of all cases [2,3]. Although the clinical incidence of bleeding in patients with rectal varices is 0.5-3.6%, the rupture of rectal varices can lead to massive and life-threatening hemorrhage [2].…”

Section: Discussionmentioning

confidence: 99%

“…Rectal varices are a type of ectopic varices that occur outside of the gastroesophageal region. Bleeding from rectal varices is rare; however, it has the potential to cause massive life-threatening hemorrhage [2].…”

Section: Introductionmentioning

confidence: 99%

“…Various treatments, such as surgical or endoscopic ligation, endoscopic injection sclerotherapy (EIS), percutaneous transhepatic obliteration (PTO) with modified techniques, transjugular intrahepatic portosystemic shunt (TIPS), and balloon-occluded retrograde transvenous obliteration (BRTO), have been used to control bleeding from rectal varices; however, there is no standard treatment for the condition [2][3][4][5][6][7][8][9][10]. In general, rectal varices have numerous drainage vessels that pass through the pelvic venous plexus; therefore, BRTO is usually not feasible for rectal varices, owing to their complex hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Retrograde Transvenous Obliteration in a Patient with a History of Sigmoidectomy

Nagai

Miyayama

Yamashiro

et al. 2016

Interventional Radiology

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Rectal varices most commonly develop in patients with portal hypertension due to liver cirrhosis. Although rectal varices rarely cause bleeding, their rupture can lead to life-threatening massive hemorrhages. Balloonoccluded retrograde obliteration (BRTO) is feasible in cases of varices involving a single or a few drainage vessels. Although rectal varices usually have numerous drainage vessels, the present case involved a single drainage vessel. The unusual presentation of the current case was considered to have been caused by a previous surgery for sigmoid colon carcinoma. BRTO was successfully performed through the left internal iliac vein, achieving complete hemostasis of the rectal varices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Retrograde Transvenous Obliteration in a Patient with a History of Sigmoidectomy

Nagai

Miyayama

Yamashiro

et al. 2016

Interventional Radiology

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“…A more recent article reported the success of BRTO as an additional therapy to surgical suture in controlling bleeding rectal varices with 1.26 cm feeding vessel. However, the patient died 6 mo later from liver failure [65] .…”

Section: Endoscopic Band Ligationmentioning

confidence: 95%

Management of rectal varices in portal hypertension

Khalloufi

Laiyemo

2015

WJH

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“…BRTO resulted in resolution of encephalopathy but was noted to worsen pre-existing oesophageal varices. More recently, BRTO was shown to be successful in conjunction with surgical suturing, in controlling bleeding rectal varices with a large (1.26 cm) feeding vessel, although the patient died 6 months post procedure from liver failure [85].…”

Section: Brtomentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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Purpose of Review The purpose of this review is to summarize available strategies for the diagnosis and management of bleeding anorectal varices. Recent Findings Interventional radiological procedures, including TIPS, BRTO and/or embolization, have been established as efficacious treatments, particularly in the setting of treatment failure. Summary Anorectal varices are prevalent in patients with portal hypertension. Acute bleeding is uncommon, but can be massive and life-threatening. Anorectal varices should be considered as a differential diagnosis in any patient with cirrhosis or portal hypertension who presents with lower gastrointestinal bleeding. No evidence-based guidelines exist to guide the management of bleeding anorectal varices, which typically requires a multidisciplinary team of endoscopists, hepatologists, surgeons and interventional radiologists. Administration of prophylactic antibiotics and vasoactive therapy is recommended based on efficacy in bleeding oesophageal varices. Urgent endoscopy should be performed in all patients. Endoscopic sclerotherapy has the greatest body of evidence and should be considered the first-line therapy; efficacy and safety may be increased if this is performed with endoscopic ultrasound. Endoscopic banding or obturation are alternative first-line treatments; all methods offer a technically simple and efficacious method of achieving haemostasis, and local expertise will determine which procedure is employed.

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Therapeutic strategy for patients with bleeding rectal varices complicating liver cirrhosis

Abstract: Bleeding from rectal varices was controlled satisfactorily by the therapeutic strategy of selecting EVL, EIS or B-RTO as an additional therapy according to the size and hemodynamics of the varices.

Cited by 21 publications

References 20 publications

Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Retrograde Transvenous Obliteration in a Patient with a History of Sigmoidectomy

Successful Treatment of Bleeding Rectal Varices with Balloon-Occluded Retrograde Transvenous Obliteration in a Patient with a History of Sigmoidectomy

Management of rectal varices in portal hypertension

The Management of Bleeding from Anorectal Varices

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