Recent Trend of Variceal Bleeding in Patients with Portal Hypertension and its Treatments Including Ectopic Varices - Abstract
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 chole dochojejunostomy, 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.