Clinical Study Comparing Bleeding and Nonbleeding Rectal Varices

Shudo, Ryushi; Yazaki, Yasuyuki; Sakurai, Shintaro; Uenishi, Hiroshi; Yamada, Hideaki; Sugawara, Kayoko

doi:10.1055/s-2002-20289

Cited by 53 publications

(42 citation statements)

References 13 publications

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“…Concerning the prediction of hemorrhage from rectal varices, Shudo et al reported that the prevalence of hemorrhage was significantly higher in patients with rectal varices of form and/or with a positive "red color (RC)" sign [1] . However, the RC sign is observed in only 40% of rectal varices [3] .…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of rectal varices varies among different reports (3.6-9%) [1,2] , accounting for 10% or less of patients with portal hypertension. According to a nationwide survey of ectopic varices in Japan from 2001 to 2005, rectal varices were the most common type of ectopic varices; the number of patients with rectal varices was 77 [3] .…”

Section: Introductionmentioning

confidence: 99%

“…Anorectal varices with massive bleeding are not common complications in patients with portal hypertension. The risk of rectal variceal rupture reported in the literature is somewhat variable (2-3.6%) [1,4,5] , accounting for 5% or less of patients with portal hypertension. However, once ruptured, they can be life-threatening.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Successful Endoscopic Treatment of Bleeding Anorectal Varices in a Patient with Advanced Pancreatic Cancer

Nakanowatari

Sato

Iida

et al. 2015

Journal of Gastroenterology and Hepatology Research

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A 78-year-old female with massive hematochezia showed an extrahepatic portal vein obstruction (EHO) and rectal varices due to advanced pancreatic cancer with computed tomography (CT). Endoscopy revealed enlarged rectal varices and external anal varices with a reddish fibrin plug, and we diagnosed the rupture of anorectal varices near the anal verge. We first performed endoscopic injection sclerotherapy (EIS) for rectal varices under fluoroscopy. After EIS, endoscopic variceal ligation (EVL) was performed for the fibrin plug. Following treatment, the patient experienced no further episodes of bleeding during the three months up to her death.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Successful Endoscopic Treatment of Bleeding Anorectal Varices in a Patient with Advanced Pancreatic Cancer

Nakanowatari

Sato

Iida

et al. 2015

Journal of Gastroenterology and Hepatology Research

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“…The prevalence of haemorrhage from anorectal varices is significantly increased in larger varices and in patients with high-risk stigmata such as a positive "red colour" sign [26]. There is no evidence to suggest that the incidence of bleeding is increased with the presence of oesophageal variceal bleeding, a history of previous treatment of oesophageal varices or the aetiology of portal hypertension [6,26].…”

Section: Pathophysiology Aetiology and Prevalence Of Anorectal Varicesmentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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Purpose of Review The purpose of this review is to summarize available strategies for the diagnosis and management of bleeding anorectal varices. Recent Findings Interventional radiological procedures, including TIPS, BRTO and/or embolization, have been established as efficacious treatments, particularly in the setting of treatment failure. Summary Anorectal varices are prevalent in patients with portal hypertension. Acute bleeding is uncommon, but can be massive and life-threatening. Anorectal varices should be considered as a differential diagnosis in any patient with cirrhosis or portal hypertension who presents with lower gastrointestinal bleeding. No evidence-based guidelines exist to guide the management of bleeding anorectal varices, which typically requires a multidisciplinary team of endoscopists, hepatologists, surgeons and interventional radiologists. Administration of prophylactic antibiotics and vasoactive therapy is recommended based on efficacy in bleeding oesophageal varices. Urgent endoscopy should be performed in all patients. Endoscopic sclerotherapy has the greatest body of evidence and should be considered the first-line therapy; efficacy and safety may be increased if this is performed with endoscopic ultrasound. Endoscopic banding or obturation are alternative first-line treatments; all methods offer a technically simple and efficacious method of achieving haemostasis, and local expertise will determine which procedure is employed.

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“…Their prevalence in patients with cirrhosis is between 38% and 56%, whereas their prevalence in extrahepatic portal vein obstruction was reported between 63% and 94% [3,5] . Despite the high prevalence of rectal varices, clinically significant bleeding is rare and occurs in 0.5%5% of patients [6] . While the management of esophageal varices has been well established [7] , the optimal treatment of rectal varices remains to be determined.…”

Section: Introductionmentioning

confidence: 99%