Clinical and endoscopic features of gastric varices secondary to splenic vein occlusion

Sato, Takahiro; Yamazaki, Katsu; Akaike, Jun; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi

doi:10.1111/j.1872-034x.2008.00376.x

Cited by 11 publications

(14 citation statements)

References 25 publications

(57 reference statements)

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“…Increased blood flow in these vessels dilates submucosal veins of the stomach, causing gastric varices that often do not demonstrate clinical symptoms, but can result in hypersplenism or gastrointestinal hemorrhage. Gastric varices due to splenic vein occlusion show a round fundal region at the center, with varices that expanded to the greater curvature of the gastric body 12–14. However, neither portal vein thrombosis nor splenic vein thrombosis was evident on CT in this patient.…”

Section: Discussionmentioning

confidence: 66%

Bleeding from gastric body varices effectively treated with endoscopic band ligation

Sato¹,

Kitagawa²

2012

IMCRJ

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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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Section: Discussionmentioning

confidence: 66%

Bleeding from gastric body varices effectively treated with endoscopic band ligation

Sato¹,

Kitagawa²

2012

IMCRJ

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“…There is a strong association between pancreatic diseases and splenic vein this condition may cause hypersplenism or gastrointestinal bleeding due to gastric varices. In previous studies of splenic vein occlusion, gastrointestinal bleeding has been reported to occur in 16-78% of patients [8,9,13,[21][22][23][24]. Sutton et al [9] found 53 cases of such occlusion, and reported a 64% incidence of upper gastrointestinal bleeding.…”

Section: Pathophysiology/symptoms Of Left-sided Portal Hypertensionmentioning

confidence: 99%

“…Additional images resulting from ECDUS color analysis of gastric variceal flow clearly depicted a round fundal region at the center, with varices that expanded to the curvatura ventriculi major of the gastric body on gastric varices due to splenic vein occlusion (Figures 3a and 3b) [23]. Variceal location of ordinary gastric varices was classified as fundal (located far from the cardiac orifice) and cardiac and fundal (located between the cardiac orifice and the fundus), however, there was no case with varices expanding to the curvatura ventriculi major of the gastric body with ECDUS findings of ordinary gastric varices [30].…”

Section: Diagnosis Of Gastric Varices Secondary To Left-sided Portal mentioning

confidence: 99%

“…However, it is now the first-choice treatment worldwide for obliteration of bleeding gastric varices. EIS using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion [23,54]. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated.…”

Section: Treatments Of Gastric Varices Secondary To Left-sided Portalmentioning

confidence: 99%

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Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Kimura¹

2013

Pancreat Disord Ther

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Sato et al., Pancreatic Dis Ther 2013, S3 http://dx.doi.org/10.4172/2165 Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases Takahiro Sato*, Sho Kitagawa, Mutsuumi Kimura, Takumi Ohmura, Yoshiyasu Karino and Jouji Toyota Department of Gastroenterology, Sapporo Kosei General Hospital, Japan occlusion because of the splenic vein, s anatomy. Sutton et al. reported that 35% of their cases of isolated splenic vein occlusion were caused by tumors and only 17% by pancreatitis [9]. On the other hand, Sakorafas et al. found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]. There is a possible pathogenetic mechanism implying the increased intra-abdominal pressure leading to compression of the splenic vein in the case of pancreatic pseudocyst [19,20].Due to splenic vein occlusion, splenic venous flow must drain into collateral veins (short gastric vein and left gastroepiploic vein). Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.Although splenic vein occlusion is commonly silent clinically, AbstractGastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches.Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body.Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the sp...

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“…SPH is a clinical syndrome of local portal hypertension induced by splenic vein thrombosis due to primary pancreatic diseases, which usually include chronic pancreatitis, pancreatic pseudocysts and pancreatic carcinomas [2]. Gastric variceal bleeding resulting from SPH of severe acute pancreatitis is quite rare especially in the acute stage, having been reported only sporadically, and the definitive therapeutic method of such lesions is sometimes difficult and controversial [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Treatment of Rare Gastric Variceal Bleeding in Acute Pancreatitis Using Embolization of the Splenic Artery Combined with Short Gastric Vein

Li¹,

Zhao²

2012

Case Rep Gastroenterol

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In the acute stage of pancreatitis, sinistral portal hypertension is a rare reason for gastric variceal bleeding. Here we report a 20-year-old female patient with massive upper gastrointestinal hemorrhage 7 days after an episode of severe acute pancreatitis. Computed tomography showed gastric varices caused by splenic venous thrombosis. Emergency endoscopic examination was performed, however tissue adhesive utilized to restrain the bleeding was not successful. Although interventional therapy was controversial to treat the gastric variceal hemorrhage resulting from sinistral portal hypertension, the bleeding was successfully treated by embolization of the splenic artery combined with short gastric vein. Two weeks after the interventional the patient was discharged from our hospital without recurrence of bleeding. Embolization of the splenic artery combined with short gastric vein proved to be an effective emergency therapeutic method for gastric variceal bleeding caused by sinistral portal hypertension in the acute stage of pancreatitis.

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Clinical and endoscopic features of gastric varices secondary to splenic vein occlusion

Abstract: ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion. Treatment should take into account the diseases underlying these conditions.

Cited by 11 publications

References 25 publications

Bleeding from gastric body varices effectively treated with endoscopic band ligation

Bleeding from gastric body varices effectively treated with endoscopic band ligation

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Treatment of Rare Gastric Variceal Bleeding in Acute Pancreatitis Using Embolization of the Splenic Artery Combined with Short Gastric Vein

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