Complete Eradication of Bleeding Duodenal Varices with Endoscopic Polydocanol Sclerotherapy

Abstract

Bleeding from duodenal varices is a rare complication of portal hypertension, occurring in only 0.4% of these patients and is often life-threatening because of the difficulty in diagnosis and treatment. Treatment options include surgical procedures and endoscopic and endovascular treatments. A 48-year-old female cirrhotic patient was admitted to our clinic with upper gastrointestinal (GI) tract bleeding. Endoscopic examination revealed nonbleeding Lm, Cb, RC (+), F3-F3-F2 esophageal and nodular-bleeding-oozing duodenal varices. Esophageal varices were eradicated with band ligation at two sessions. After one session of 2% polydocanol sclerotheraphy, no signs of bleeding were determined. Complete eradication was achieved after five sessions and 1 year apart from the initial treatment duodenal varices were eradicated. Although duodenal varices are rare, they are frequently fatal. There are limited data regarding optimal treatment. Successful treatment depends both on patient factors (hepatic synthetic function, comorbidities, size/location of the varices) and center expertise. Long-term eradication is variable and may depend on the cause and extensiveness of the ectopic varices.How to cite this articleTemel T, Aktas A, Ozgenel SM, Özakyol A. Complete Eradication of Bleeding Duodenal Varices with Endoscopic Polydocanol Sclerotherapy. Euroasian J Hepato-Gastroenterol 2016;6(2):176-178.

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

“…Our initial search yielded 395 case reports of SIV in patients with cirrhosis, of which 76 (19.2%) reported SIV bleeding and were included for collation and analysis (9–20,21–30,31–40,41–50,51–60,61–78). Mean age was 52.4 years (range 40–68), 32 were women, and 44 were men.…”

Hemorrhagic Shock from a Duodenal Ulcer Eroding into an Ectopic Varix

“…Treatment of DV is aimed at occlusion of the portal venous perforators as opposed to arterial embolization used in non-variceal, peptic ulcer bleeding. The current therapeutic options include endoscopic varix band ligation (EVL), TIPS, percutaneous transhepatic obliteration, balloon-occluded retrograde transvenous obliteration, and surgery [ 5 , 6 ]. However, given the scarcity of literature, there is a lack of consensus regarding a standard treatment approach for DV.…”

“…However, given the scarcity of literature, there is a lack of consensus regarding a standard treatment approach for DV. The most common therapeutic intervention is EVL, although the rebleeding risk remains high due to the minimal thickness of the duodenal wall [ 6 ]. One study evaluating the effectiveness of EVL for the treatment of DV found the overall success rate to be low at approximately 16% [ 6 ].…”

Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review

“…In addition, some cases may be refractory to the band given the anatomy of the duodenal varices [ 46 ]. Sclerosants and tissue adhesives were injected into target intravarices or feeding collateral vessels to obtain the eradication of varices [ 57 – 59 ]. Third, in published studies, sclerosants and tissue adhesives included ethanolamine oleate, sodium morrhuate, absolute alcohol, polidocanol, thrombin, cyanoacrylate, and sodium tetradecyl sulfate; in addition, cyanoacrylate and ethanolamine oleate are frequently used.…”

“…Endoscopic treatment techniques theoretically increase the risk of mucosal ulcers, perforations, or other complications given the relative thinness of the duodenal wall compared to the other parts of the upper gastrointestinal tract [ 46 , 57 , 61 ]. In this systematic review, the overall rate of adverse events was 27.7%, which was comparable with 19–38% previously reported for endoscopic treatments for gastric varices [ 62 – 64 ].…”