Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension

Abstract

Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions: Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future.

The Management of Bleeding from Anorectal Varices

“…Furthermore, patients with rectal varices were frequently noted to have a history of esophageal varices (94.8%) and the majority (87%) had received endoscopic treatment of esophageal varices [23]. There is conflicting evidence regarding the occurrence of rectal varices following treatment of esophageal varices.…”

“…Some studies have suggested that injection sclerotherapy or band ligation of esophageal varices may influence the natural history of ectopic varices. In the case of anorectal varices, this is postulated to be due to development of collateral vessels in the inferior mesenteric venous system following obliteration of supplying vessels (such as the left gastric, posterior gastric or short gastric veins) which ultimately leads to the formation of rectal varices [11,23,24]. The correlation between treatment of esophageal or gastric varices and subsequent formation of anorectal varices has not been conclusively demonstrated.…”

Management of rectal varices in portal hypertension

“…However, a large study conducted in Japan by Watanabe et al [14] reported that 95% of patients with rectal varices had a history of esophageal varices and 87% of these patients had previously under gone endoscopic variceal obliteration for esophageal varices. The mechanism of rectal varices after treatment of esophageal or gastric varices is thought to be the result of obliteration of supplying vessels such as the left gastric, posterior gastric and short gastric veins leading to development of collateral vessels of the inferior mesenteric venous system and thus the formation of rectal varices.…”

“…The mechanism of rectal varices after treatment of esophageal or gastric varices is thought to be the result of obliteration of supplying vessels such as the left gastric, posterior gastric and short gastric veins leading to development of collateral vessels of the inferior mesenteric venous system and thus the formation of rectal varices. In this nationally representative study in Japan, the most frequent afferent vessel to the rectal varices was the inferior mesenteric vein, followed by the superior rectal vein and the efferent vessels included the internal iliac vein and the inferior rectal vein [14] .…”

Hepatobiliary Quiz Answers – 18 (2016)

“…These constitute upto 5% of variceal bleeds in patients with intrahepatic portal hypertension, and 20% to 30% of those with extrahepatic portal hypertension. [1][2][3] Of all patients with ectopic varices, the frequency according to site are as follows-duodenal varices(32.9%), jejunum(4%), ileum (1.2%), colon(3.5%), rectal (44.5%) and peristomal (5.8%) 4 . Another study shows the prevalence of anorectal varices to be 77.7%, and that they are much more common in patients with noncirrhotic portal hypertension (89.3%).…”