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"Downhill" varices: A rare cause of esophageal hemorrhage
Areia,M.; Rom?ozinho,J. M.; Ferreira,M.; Amaro,P.; Freitas,D.;
Revista Espa?ola de Enfermedades Digestivas , 2006, DOI: 10.4321/S1130-01082006000500006
Abstract: "downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. in our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. their etiology differs from that of the usual "uphill' varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. we report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.
Role of serotonin in development of esophageal and gastric fundal varices  [cached]
Jelena S Rudi?, ?or?e M ?ulafi?, Du?ko S Mirkovi?, Rada S Je?i?, Miodrag N Krsti?
World Journal of Gastroenterology , 2010,
Abstract: AIM: To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices.METHODS: This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis.RESULTS: The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L, P < 0.0001). There was no significant correlation between serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs = -0.217, P > 0.05). However, the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs = -0.601, P < 0.01).CONCLUSION: Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices, indicating the clinical value of serotonergic receptor blockers in these patients.
"Downhill" varices: A rare cause of esophageal hemorrhage Varice "Downhill": Una causa extra a de sangrado esofágico  [cached]
M. Areia,J. M. Rom?ozinho,M. Ferreira,P. Amaro
Revista Espa?ola de Enfermedades Digestivas , 2006,
Abstract: "Downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. In our series, hemorrhage due to "Downhill" varices represents 0.1% of all acute esophageal variceal bleeding. Their etiology differs from that of the usual "uphill' varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. We report a case of an 89-year-old male with hemorrhagic "Downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.
The diameter of the originating vein determines esophageal and gastric fundic varices in portal hypertension secondary to posthepatitic cirrhosis
Zhou, Hai-ying;Chen, Tian-wu;Zhang, Xiao-ming;Wang, Li-ying;Zhou, Li;Dong, Guo-li;Zeng, Nan-lin;Li, Hang;Chen, Xiao-li;Li, Rui;
Clinics , 2012, DOI: 10.6061/clinics/2012(06)11
Abstract: objective: the aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. methods: a total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. patients with and without esophageal and gastric fundic varices were enrolled in group 1 and group 2, respectively. group 1 was composed of subgroup a, consisting of patients with varices, and subgroup b consisted of patients with varices in combination with portal vein-inferior vena cava shunts. the diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. results: the originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. the splenic vein diameter in group 1 was larger than that in group 2, whereas no differences in portal vein diameters were found between groups. in group 1, the splenic vein diameter in subgroup a was larger than that in subgroup b. a cut-off splenic vein diameter of 8.5 mm achieved a sensitivity of 83.3% and specificity of 58.1% for predicting the varices. for discrimination of the varices in combination with and without portal vein-inferior vena cava shunts, a cut-off diameter of 9.5 mm achieved a sensitivity of 66.7% and specificity of 60.0%. conclusion: the diameter of the splenic vein can be used to predict esophageal and gastric fundic varices and their patterns.
Diagnosis value of contrast-enhanced ultrasound in the application of esophageal gastric varices
超声造影对食管胃底静脉曲张的诊断价值

YANG Shu-ping,WANG Kan-jian,SHEN Hao-lin,
杨舒萍
,王康健,沈浩霖

中华医学超声杂志(电子版) , 2010,
Abstract: Objective To evaluate the applications of contrast-enhanced ultrasound in the diagnosis of esophageal gastric varices.Methods A total of 93 patients were classified into two groups by gastroscopy:one was observation group including 48 patients with esophageal gastric varices and the other was control group including 45 patients without esophageal gastric varices.By contrast-enhanced ultrasound,the thickness of the lower esophageal bilayer mucosa and submucosa,AT and TP of two groups were observed and compar...
Gastric and ectopic varices – newer endoscopic options  [cached]
D. Christodoulou,E. V. Tsianos,P. Kortan,N. Marcon
Annals of Gastroenterology , 2007,
Abstract: Bleeding from esophageal and gastric varices is the most lifethreatening complication of liver cirrhosis and portal hypertension. While for esophageal varices the endoscopic treatment is well established and common practice is followed worldwide, this is not the case for gastric varices. Gastric varices bleed less frequently but more severely than esophageal ones and are classified in certain subtypes according to their location and their size or configuration. In this review, the treatment options for bleeding esophageal and gastric varices will be presented. Emphasis will be given on the treatment of gastric varices with cyanoacrylate. In addition, a short description of ectopic varices will be made. Key Words: treatment of gastric varices, ectopic varices, cyanoacrylate, glue, variceal bleeding.
Endoscopic Color Doppler Ultrasonography for Esophagogastric Varices  [PDF]
Takahiro Sato,Katsu Yamazaki
Diagnostic and Therapeutic Endoscopy , 2012, DOI: 10.1155/2012/859213
Abstract: Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Endoscopic ultrasonography not only visualizes the surface of the varices but also provides detailed information about their internal structure. The direction of blood flow can be determined and its velocity measured only via endoscopic color Doppler ultrasonography (ECDUS). This can show graphically esophageal varices, paraesophageal veins, and passageways in esophageal variceal patients and gastric varices, perigastric collateral veins in gastric variceal patients. It is important to evaluate the hemodynamics of the portal venous system when treating the esophago-gastric varices. ECDUS is a useful modality for the evaluation of the detailed hemodynamics and the therapeutic effects of esophago-gastric varices. 1. Introduction Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Endoscopic injection sclerotherapy (EIS) [1] and endoscopic variceal ligation (EVL) [2] are effective treatments for esophageal variceal bleeding. In Japan, there appears to be controversy in deciding which of the two is the best therapy for elective and prophylactic cases. Therefore, it is important to evaluate the hemodynamics of the portal venous system when determining the optimal choice of treatment for patients with portal hypertension. Recent technical advances have offered clinicians increasingly greater clarity in visualizing gastric varices. Gastric variceal bleeding is a common complication of portal hypertension and is associated with higher morbidity and mortality rates than hemorrhage from esophageal varices [3]. Bleeding gastric varices can be treated successfully by injection of cyanoacrylate. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new approach for the obliteration of collateral vessels connecting the portal venous system and systemic circulation, and has been evaluated recently for the treatment of gastric varices [4]. Gastric fundal varices associated with large gastro-renal shunt (GRS) [5] are a good indication for B-RTO, which has been performed widely in Japan [6–9]. In this paper, we review the hemodynamics of esophagogastric varices due to portal hypertension and describe the usefulness of endoscopic color Doppler ultrasonography (ECDUS). 1.1. Hemodynamics of Esophageal Varices Hepatofugal flow in the collateral veins (left gastric vein, short gastric vein, and posterior gastric vein) is involved in the formation of esophageal varices. The left gastric vein is
Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension  [PDF]
Takahiro Sato,Jun Akaike,Jouji Toyota,Yoshiyasu Karino,Takumi Ohmura
International Journal of Hepatology , 2011, DOI: 10.4061/2011/960720
Abstract: Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5%) among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding. 1. Introduction Portal hypertension can result in either the reopening of collapsed embryonic channels or reversal of the flow within existing adult veins [1]. Whilst esophagogastric varices are the most common complication in patients with portal hypertension, ectopic varices defined by large portosystemic venous collaterals occurring anywhere in the gastrointestinal tract, other than the esophagogastric region, are less common and account for between 1% and 5% of all variceal bleeding [2, 3]. Ectopic varices that are not esophagogastric are located predominantly in the duodenum, jejunum, ileum, colon, rectum, and enterostomy stoma. Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. However, there are few reports on the clinicopathological features of ectopic varices. Endoscopic injection sclerotherapy (EIS) is now a standard procedure for the treatment of esophageal varices [4] and, recently, endoscopic band ligation (EBL) has been used widely to treat esophageal varices [5]. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new interventional modality for gastric fundic varices [6]. However, a definitive treatment has not been established for bleeding ectopic varices. In this paper, we evaluate the clinicopathological features and treatment of ectopic varices in our ward. 2. Clinicopathological Features of Ectopic Varices Esophagogastric varices are considered to be the most common complication in patients with portal hypertension, while ectopic varices (i.e., those outside the esophago-gastric region) are less common. Ectopic varices have been reported to occur at numerous sites, including 18% in the jejunum or ileum, 17% in the duodenum, 14% in the colon, 8% in the rectum, and 9% in the peritoneum [7]. From January 1994 to March 2009, we
Bleeding oesophageal varices: Therapeutic options  [PDF]
Pavlovi? A.R.,Krsti? M.N.,?uranovi? S.,Popovi? D.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0701139p
Abstract: Introduction: Emergency endoscopy plays the most important role in diagnosis and treatment of patients with esophageal variceal bleeding. Endoscopic sclerotherapy (EST), placement of esophageal band ligatures (EVL), medicamentous treatment using somatostatin and its derivatives and balloon tamponade are the methods most frequently applied in treatment of the bleeding esophageal varices. Patients and methods: Endoscopic reports on the patients with bleeding esophageal and gastric varices were retrospectively analyzed in the emergency unit of the Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia over the five-year period - since January 2001 till December 2005. Results: The total of approximately 3, 954 emergency upper endoscopies were performed due to the upper gastrointestinal tract bleeding. Out of the total number of patients, bleeding was diagnosed in 324 (8.2%) patients due to the esophageal varices. In the group of patients with bleeding esophageal varices, the total of 252 (77.8%) males and 72 (22.2%) females averagely aged 56.8+7.5 years (range 24 - 80 years) were examined. The primary sclerosant therapy with absolute alcohol was applied in 118 (36.4%) patients, while Blakemore probe tamponade was performed in 145 (44.8%) patients with bleeding esophageal varices. The total of 240 (74.1%) patientswere treated with vasoactive substances (somatostatin and its analogues), as additional therapy and control of the primary hemostasis. It was evidenced that out of 118 patients intra and paravariceally treated with the sclerosant agent (absolute alcohol) hemostasis was achieved in 47 (39.8%). Out of 145 patients subjected to Blakemore probe placement, bleeding was successfully arrested in 117 (80.7%) patients. Somatostatin and its analogues as primary and only treatment of the bleeding esophageal varices were applied in 71 (29.6%) patients, while in the remaining 169 (70.4%) patients, they were applied as additional therapy to the endoscopic sclerotherapy and mechanical treatment of bleeding. Out of 71 patients treated with somatostatin preparations as the only therapeutic option, 45 (63.4%) responded positively by arrest of bleeding for 72 hours. Conclusion: Treatment of the acute bleeding esophageal varices is focused on the arrest of bleeding, prevention of early recurrent bleeding and reduction of mortality. Based on the most recent studies, efficacy of the modern endoscopic therapy in the form of sclerotherapy and band ligature placement, as well as application of vasoactive substances reaches up to 90%. Our results evidence minim
Prevention and Management of Gastroesophageal Varices in Cirrhosis  [PDF]
Yen-I Chen,Peter Ghali
International Journal of Hepatology , 2012, DOI: 10.1155/2012/750150
Abstract: Variceal hemorrhage is one of the major complications of liver cirrhosis associated with significant mortality and morbidity. Its management has evolved over the past decade and has substantially reduced the rate of first and recurrent bleeding while decreasing mortality. In general, treatment of esophageal varices can be divided into three categories: primary prophylaxis (prevention of first episode of bleeding), management of acute bleeding, and secondary prophylaxis (prevention of recurrent hemorrhage). The goal of this paper is to describe the current evidence behind the management of esophageal varices. We will discuss indications for primary prophylaxis and the different modes of therapy, pharmacological and interventional treatment in acute bleeding, and therapeutic options in preventing recurrent bleeding. The indications for TIPS will also be reviewed including its possible benefits in acute variceal hemorrhage.
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