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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.
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
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.
Endoscopic Hemostatic Treatment of Gastric Varices during Pregnancy by Injection of Histoacryl  [PDF]
Nora Bousfiha, Najoua Bousfiha, Chahrazad Bouchikhi, Abdelaziz Banani, Adil Ibrahimi, Nourdin Aqodad
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.44022
Abstract: The occurrence of pregnancy is relatively rare in patients with portal hypertension, and has been reported as clinical cases. However, few studies have evaluated the effectiveness of injecting histoacryl during pregnancy. The choice of treatment for varicose bleeding during pregnancy has been described in the literature based on the elastic ligature. We report the second case, to our knowledge, of treatment of bleeding gastric varices by injection of histoacryl with good maternal and fetal development.
Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses  [PDF]
Lior Menasherian-Yaccobe,Nathan T. Jaqua,Patrick Kenny
Case Reports in Surgery , 2013, DOI: 10.1155/2013/273531
Abstract: A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses. 1. Introduction Gastric varices are less common than esophageal varices in patients with portal hypertension, occurring in up to 33% of patients [1–3]. Gastric varices are more common in patients with noncirrhotic portal hypertension and extrahepatic portal vein thrombosis, are associated with a lower incidence of bleeding, and have a higher mortality rate than esophageal varices [1–3]. Optimal management of gastric variceal bleeding is debatable, because of lack of data from large randomized controlled trials [3]. We present a case of gastric variceal bleeding caused by prehepatic venous thrombosis from essential thrombocythemia that was successfully treated with therapeutic splenectomy. 2. Case Report A 59-year-old female with a history of essential thrombocythemia and heterozygous prothrombin gene mutation was hospitalized for abdominal pain. Evaluation revealed portal, superior mesenteric and splenic vein thrombosis, and she was started on warfarin (Figures 1, 2, and 3). She presented two months later with one week of dull epigastric abdominal pain which was worse with movement and food and better with
Successful endoscopic treatment of bleeding gastric varices with n-butyl-2-cyanoacrylate and lipiodol mixture injection
Ya?ar Tuna,Adnan Ta?,Seyfettin K?klü
Dicle Medical Journal , 2011,
Abstract: Objectives: The aim of this study was to determine effect of N-Butyl-2 Cyanoacrylate (CA) and lipiodol mixture injection for hemostasis of bleeding gastric varices or lesions, which had bled from gastric varices.Materials and methods Fifteen patients with active bleeding or bleeding findings within two weeks who admitted to endoscopic unit of a low volume medical center were evaluated retrospectively between 2003 and 2010. We carried out endoscopic sclerotherapy successfully to gastric varices with combination of N-Butyl-2 Cyanoacrylate and Lipiodol (CALM), with dramatical success over months after sessions of sclerotherapy for each patient.Results: Sclerotherapy with cyanoacrylate achieved hemostasis in all actively bleeding nine patients initially. Rebleeding occurred in a patient 24 hours later and in another patient two months later (2/15, 13.3%). Eradication of gastric varices was achived in 13 (86.7 %) patients during follow-up. One patient was operated because of rebleeding. One patient died as a result of liver failure. Five-year survival rate of the patients after eradication of gastric varices was 14/15 (93.3%).Conclution: This study indicated that sclerotherapy with N-Butyl-2 Cyanoacrylate and lipiodol mixture is an effective treatment method for patients with bleeding gastric varices and also for eradication of gastric varices.
Bleeding from gastric body varices effectively treated with endoscopic band ligation  [cached]
Sato T,Kitagawa S
International Medical Case Reports Journal , 2012,
Abstract: Takahiro Sato, Sho KitagawaDepartment of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, JapanAbstract: A 55-year-old man with alcoholic liver cirrhosis was admitted to hospital with tarry stools. Videoendoscopy examination on admission revealed blood oozing from the greater curvature of the gastric body (ectopic varices). Endoscopic ultrasonography and computed tomography were used in making the diagnosis. Endoscopic band ligation (EBL) was performed for the bleeding site of these varices. The patient experienced no further episodes of bleeding during the 6 months following treatment with EBL. EBL was very effective in treating the bleeding from gastric body varices.Keywords: ectopic varices, endoscopic band ligation, gastric body varices, portal hypertension
Ectopic Varices Rupture in the Gastroduodenal Anastomosis Successfully Treated with N-butyl-2-cyanoacrylate Injection
Onozato,Yasuhiro,Kakizaki,Satoru,Iizuka,Haruhisa,Mori,Kazuyo
Acta Medica Okayama , 2007,
Abstract: The term "ectopic varices" is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70-year-old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth-I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices, there were no obvious bleeding points. After removal of the coagula, ectopic varices and a fibrin plug were observed on the gastroduodenal anastomosis. During the observation, blood began to spurt from the fibrin plug. N-butyl-2-cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood flow around the bleeding point, as indicated by lipiodol deposition, had decreased, and no feeding vein was observed. Endoscopic and angiographic findings are shown and the treatment for such lesions is discussed.
Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices
Eun Jung Kang, Soung Won Jeong, Jae Young Jang, Joo Young Cho, Sae Hwan Lee, Hyun Gun Kim, Sang Gyune Kim, Young Seok Kim, Young Koog Cheon, Young Deok Cho, Hong Soo Kim, Boo Sung Kim
World Journal of Gastroenterology , 2011,
Abstract: AIM: To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl for treatment of gastric variceal bleeding and prophylaxis.METHODS: Between January 1994 and March 2010 at SoonChunHyang University Hospital, a total of 127 patients with gastric varices received Histoacryl injections endoscopically. One hundred patients underwent endoscopic Histoacryl injections because of variceal bleeding, the other 27 patients received such injections as a prophylactic procedure.RESULTS: According to Sarin classification, 56 patients were GOV1, 61 patients were GOV2 and 10 patients were IGV. Most of the varices were large (F2 or F3, 111 patients). The average volume of Histoacryl per each session was 1.7 ± 1.3 cc and mean number of sessions was 1.3 ± 0.6. (1 session-98 patients, 2 sessions-25 patients, ≥ 3 sessions-4 patients). Twenty-seven patients with high risk of bleeding (large or fundal or RCS+ or Child C) received Histoacryl injection as a primary prophylactic procedure. In these patients, hepatitis B virus was the major etiology of cirrhosis, 25 patients showed GOV1 or 2 (92.6%) and F2 or F3 accounted for 88.9% (n = 24). The rate of initial hemostasis was 98.4% and recurrent bleeding within one year occurred in 18.1% of patients. Successful hemostasis during episodes of rebleeding was achieved in 73.9% of cases. Median survival was 50 mo (95% CI 30.5-69.5). Major complications occurred in 4 patients (3.1%). The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions. None of the 27 subjects who were treated prophylactically experienced treatment-related complications. Cumulative survival rates of the 127 patients at 6 mo, 1, 3, and 5 years were 92.1%, 84.2%, 64.2%, and 45.3%, respectively. The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION: Histoacryl injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.
Bleeding from gastric body varices effectively treated with endoscopic band ligation
Sato T, Kitagawa S
International Medical Case Reports Journal , 2012, DOI: http://dx.doi.org/10.2147/IMCRJ.S36882
Abstract: leeding from gastric body varices effectively treated with endoscopic band ligation Case report (750) Total Article Views Authors: Sato T, Kitagawa S Published Date October 2012 Volume 2012:5 Pages 69 - 72 DOI: http://dx.doi.org/10.2147/IMCRJ.S36882 Received: 09 August 2012 Accepted: 03 September 2012 Published: 19 October 2012 Takahiro Sato, Sho Kitagawa Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan Abstract: A 55-year-old man with alcoholic liver cirrhosis was admitted to hospital with tarry stools. Videoendoscopy examination on admission revealed blood oozing from the greater curvature of the gastric body (ectopic varices). Endoscopic ultrasonography and computed tomography were used in making the diagnosis. Endoscopic band ligation (EBL) was performed for the bleeding site of these varices. The patient experienced no further episodes of bleeding during the 6 months following treatment with EBL. EBL was very effective in treating the bleeding from gastric body varices.
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