Recent Trend of Variceal Bleeding in Patients with Portal Hypertension and its Treatments Including Ectopic Varices
نویسنده
چکیده
Aims: We investigated recent trend of variceal bleeding in patients with portal hypertension and its treatments including ectopic varices. Methods: One hundred forty-four patients with variceal bleeding events and portal hypertension were evaluated retrospectively from December 2012 to June 2016. Results: Sites of 144 variceal bleeding were as follows; esophageal varices in 67, cardiac varices in 24, fundal varices in 10, and ectopic varices in 43 (29.9%). Ectopic varices were rectal varices in 27, duodenal varices in 4, anastomotic varices after choledochojejunostomy in 2, jejunal varices in 1, gastric body varices in 7 and stomal varices in 2. Endoscopic band ligation (EBL) was successfully performed for 56 esophageal varices and endoscopic injection sclerotherapy (EIS) using 5% ethanolamine oleate (EO) for 6 esophageal varices, and EBL plus EIS for 5 esophageal varices, respectively. EBL was performed successfully for 9 cardiac varices and EIS using EO for 8 cardiac varices, and EBL plus EIS for 7 cardiac varices, respectively. EIS using cyanoacrylate (CA) was successfully performed for 9 fundal varices and EIS using EO for 1 fundal variceal patient. EIS using EO was performed successfully for 21 rectal varices and EBL for 2 rectal varices, and EBL plus EIS for 4 rectal varices, respectively. EIS using CA was successfully performed for 3 duodenal varices and EIS plus balloon-occluded retrograde transvenous obliteration for 1 duodenal variceal patient. EIS using CA was successfully performed for 2 anastomotic varices after choledochojejunostomy, however, jejunal variceal patient who underwent percutaneous transhepatic obliteration (PTO) died 2 days after the treatment due to poor condition. EBL was successfully performed for 6 gastric body varices, and EIS using CA was successfully performed for 1 gastric body varices. Percutaneous injection sclerotherapy using EO was successfully performed for 2 stomal varices. No significant complications were observed. Conclusions: Recently, the frequency of ectopic varices has been increasing. Endoscopic treatments and interventional radiology have been performed successfully and safety for variceal bleeding including ectopic varices.
منابع مشابه
The news of treatment of variceal upper gastrointestinal bleeding
Variceal bleeding is one of the dreaded complications of portal hypertension. Although its prognosis has improved over the last several decades, it still carries substantial mortality. Although most portal hypertensive bleeds result from the ruptured distal esophageal varices, bleeding from other sources such gastric varices, portal hypertensive gastropathy, and ectopic varices can lead to clin...
متن کاملRecurrent and troublesome variceal bleeding from parastomal caput medusae.
Variceal bleeding is common in chronic liver disease and is a frequent cause of acute upper gastrointestinal bleeding. The most common site of varices is the lower oesophagus but they may occur at any location where there are portosystemic anastomoses and collateral vascular formation. Location of ectopic varices at the site of enterocutaneous stomas is rare. We report on three cases of recurre...
متن کاملEctopic gastrointestinal variceal bleeding with portal hypertension
Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we r...
متن کاملEctopic varices in portal hypertension.
Varices most commonly occur and bleed in the gastro-esophageal region but ectopic varices can arise at extra-gastro-esophageal locations in the gastrointestinal tract like duodenum, jejunum, ileum, colon, rectum, biliary tree and at the site of a surgical ostomy. These varices pose diagnostic as well as therapeutic challenges during endoscopic procedures. Ectopic varices can also occur outside ...
متن کاملGastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension
Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic...
متن کامل