Complete eradication of duodenal varices after endoscopic injection sclerotherapy with ethanolamine oleate: a case report

Seo, Yeon Seok; Kwon, Yong Dae; Park, Sanghoon; Keum, Bora; Park, Beom Jin; Kim, Yong Sik; Jeen, Yoon Tae; Chun, Hoon Jai; Kim, Chang Duck; Ryu, Ho Sang; Um, Soon Ho

doi:10.1016/j.gie.2007.08.027

Cited by 19 publications

(11 citation statements)

References 15 publications

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“…And also it is difficult to achieve complete long-term eradication of varices with EVL alone, because of the insufficient effect of EVL on the feeding collateral vessels 18. EIS has been performed for treatment of bleeding duodenal varices and suggested as a practical and effective measure 7,13. However, it carries a risk of perforation, tissue injury, and embolism.…”

Section: Discussionmentioning

confidence: 99%

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

et al. 2011

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Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.

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Section: Discussionmentioning

confidence: 99%

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

et al. 2011

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“…After the obliteration of duodenal perforators, collateral flow in PDV, which are generally not obliterated by endotherapy, can continue to transmit some of the pressure away from the DV toward the systemic veins. 44 Thus, obliterating DV close to the inflowing duodenal perforators may be more effective in control of acute bleeding and in prevention of rebleeding in patients with DV. In our series inflow reduction was achieved as was seen by disappearance of DV on the endoscopic aspect in four cases.…”

Section: Discussionmentioning

confidence: 99%

“…44,45 Endoscopic sclerotherapy can cause severe liver damage if the flow of DV is hepatopetal. 46 Glue injection carries a high risk of thromboembolic complications and endoscopic variceal ligation (EVL) is considered unsafe for DV larger than 15 mm.…”

Section: Discussionmentioning

confidence: 99%

Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

Sharma

Mohan

Rameshbabu

et al. 2012

Journal of Clinical and Experimental Hepatology

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Background/Aims: Duodenal varices (DV) are ectopic varices which can cause massive gastrointestinal bleeding. The diagnosis of DV may be difficult; sometimes they can be hidden behind duodenal folds. The aim of the study was to evaluate DV by endoscopic ultrasound. Methods: Endoscopic ultrasound was done in patients detected or suspected to be having DV. The para duodenal varices were identified and subsequently hemodynamic evaluation of DV was done. Results: Endoscopic ultrasound identified perforators in seven cases of DV. Conclusion: The endoscopic ultrasound can help in detection of DV underlying thickened folds. It can also help in hemodynamic evaluation of DV. ( J CLIN EXP HEPATOL 2012;2:229-237)

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“…Multi-detector CT with intravenous contrast agent depicted the duodenal varices with complicated porto-systemic shunt vessels. The importance of CT during arterial portography for revealing paraumbilical varices has been reported [2,5]. Usefulness of CT-maximum intensity projection (CT-MIP) for depicting gastric varices with collateral vessels has been reported [6].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

et al. 2010

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Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a fourchannel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multidetector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

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Complete eradication of duodenal varices after endoscopic injection sclerotherapy with ethanolamine oleate: a case report

Cited by 19 publications

References 15 publications

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

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