Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices

Abstract

Background: Ectopic varices (EcVs) may cause massive bleeding, which can be difficult to control, with a high rate of mortality. The purpose of this study was to analyze the clinical characteristics of EcVs and the efficacy of endoscopic treatment. Methods: From January 2008 to July 2017, the clinical data of 150 patients with EcVs in our center were retrospectively collected and analyzed. Results: One hundred and fifty patients with EcVs (male 74.7%), with a mean age of: 54.1 ± 14.6 years were included. The prevalence of EcVs was 0.92% in gastrointestinal varices. Cirrhosis was the most common cause of EcVs (67.0%). The rates of bleeding were 57.14%, 4.34%, 30.0%, 33.3%, and 100% in the duodenal varices rectal varices, colonic varices, anastomotic varices, and small bowel varices, respectively. An age under 55 years, varices in the duodenum, and erythema were considered risk factors for EcV bleeding. Endoscopic treatments were performed in 15 patients with EcV bleeding. The follow-up period of the patients who underwent endoscopic treatment ranged from 0.5 to 24 months. The overall rate of treatment success was 73.33% for endoscopic treatment of EcV bleeding. The overall rates of rebleeding and mortality during 2 years were as high as 53.3% and 26.7%, respectively. Conclusion: Age, erythema, and the location of EcVs are considered risk factors for EcV bleeding, and the rate of bleeding is higher in patients with duodenal varices than in those with other EcVs. Endoscopic treatment is safe, effective, and feasible for controlling EcV bleeding.

Endoscopic management of bleeding ectopic varices: multicentric retrospective case series

“…Extraluminal ectopic varices may be located in the retroperitoneal, intraperitoneal, or periumbilical areas, in the gall bladder and biliary tree, at the ovary, or in the vagina [26]. Endoscopic treatment for ectopic varices requires a certain level of endoscopic experience because they are usually located in difficult sites of the gastrointestinal tract [27,28]. In our study, we did not identify any patient with ectopic varices in more than one location (mixed sites).…”

An Unusual Case of Isolated Duodenal Varices With Superior Mesenteric Vein Thrombosis

“…Duodenal varices are part of a heterogeneous group of ectopic varices that arise due to shunting within the portal vascular bed or the systemic/mesenteric vessels [ 1 ]. An uncommon manifestation of portal hypertension, DV usually occurs along with oesophageal and/or gastric varices [ 2 , 3 ]. The most common cause of DV is extrahepatic portal hypertension followed by cirrhosis.…”

Convoluted tumorous lesions at second portion of duodenum in a cirrhotic patient with massive upper gastrointestinal bleeding and shock

“…The successful rate of endoscopic treatment alone for acute duodenal variceal bleeding is 73.3%. However, 53.3% patients experience rebleeding within 1 year 4 …”