Duodenal variceal bleeding caused by chronic pancreatitis

Kao, Wei Yu; Wu, Wen‐Chieh; Chen, Ping‐Hsien; Chiou, Yi–You

doi:10.1016/j.gie.2011.05.015

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Varices in the duodenal bulb, which most frequently occur in the United States and Europe, are caused by extrahepatic portal obstruction (EHO). Several articles were reported about DV bleeding caused by EHO [25][26][27]. In Japan, duodenal varices are observed more commonly in the second portion of the duodenum [28].…”

Section: Discussionmentioning

confidence: 99%

“…EIS has been performed successfully for the treatment of duodenal variceal bleeding [32], but there were serious problem of re-bleeding of the varices [24,33]. Endoscopic therapy using n-butyl-2-cyanoacrylate is also very useful for massive duodenal variceal bleeding [27,34,35] because of the high blood velocity and blood flow. Hemorrhaging from varices in the jejunal loop, with extrahepatic portal vein obstruction after choledochojejunostomy, is a rare condition but several articles have been published [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate for gastrointestinal varices

Sato¹

2016

Gastroenterol Hepatol Endosc

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Aims: To evaluate the utility of endoscopic obliterative therapy with n-butyl-2-cyanoacrylate (tissue adhesives) for gastrointestinal varices and to investigate the incidence of serious complications.Methods: Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate was performed on 228 gastrointestinal variceal patients; 221 gastric varices, 5 duodenal varices, and 2 anastomotic varices after choledochojejunostomy. Endoscopic therapy was performed under fluoroscopy using 70% or 83% cyanoacrylate diluted with 5% Lipiodol.Results: Endoscopic obliterative therapy with cyanoacrylate for gastrointestinal varices was successful in all 228 cases. The incidence of serious complications was 4/228 (1.8%), including two cases of splenic infarction, one of pulmonary embolism, and one of an inflammatory tumor of the pancreatic tail, and all these 4 cases for gastric varices.Conclusions: Endoscopic obliterative therapy with cyanoacrylate is a useful and relatively safe method for treatment of bleeding gastrointestinal varices. Nonetheless, careful attention must be paid to avoid potentially serious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate for gastrointestinal varices

Sato¹

2016

Gastroenterol Hepatol Endosc

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“…A case of duodenal variceal bleeding secondary to chronic pancreatitis has also been reported. [13] In their series of 14 patients, Liu et al . have noted that 13 patients had underlying cirrhosis and one had EHPVO.…”

Section: Discussionmentioning

confidence: 99%

“…As reported by earlier studies, all of our patients had DV located in the first part of duodenum. [4567891011121314]…”

Section: Discussionmentioning

confidence: 99%

Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

et al. 2014

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Background:Duodenal varices (DV) although an uncommon cause, are an important cause due to the severe nature of the bleed and associated adverse outcome.Materials and Methods:We retrospectively evaluated patients with DV seen at our institution over past 4 years.Results:A total of 10 patients (nine males; mean age was 35.8 ± 7.68 years) with DV were studied. Five patients had underlying cirrhosis and five had DV because of non-cirrhotic portal hypertension (four patients had extra-hepatic portal venous obstruction and one patient had non-cirrhotic portal fibrosis). Five patients presented with upper gastrointestinal (GI) bleed, whereas in the remaining five patients DV were detected on endoscopy performed for evaluation of portal hypertension. Endoscopy revealed submucosal lesion in nine patients, whereas in one patient an initial endoscopic diagnosis of Dieulafoy's lesion was made. However endoscopic ultrasound (EUS) could clearly identify DV in all patients. Of five patients presenting with upper GI bleed, three had the esophageal varices eradicated and two presented 1st time with bleed form DV and did not have esophagogastric varices. All patients with acute upper GI bleed were initially treated with intravenous terlipressin followed by glue (n-butyl cyanoacrylate) injection in 4/5 patients with one patient refusing further endoscopic therapy. The variceal obliteration was documented by EUS in all these four patients and there has been no recurrence of bleed in these four patients over a follow-up period of 4-46 months. The five non-bleeding DV were already on beta- blockers and the same were continued. Two of these five patients succumbed to progressive liver failure with none of these five patients having GI bleed on follow-up.Conclusion:EUS is a useful investigational modality for evaluating patients with DV and endoscopic injection of glue is an effective therapy for controlling and preventing recurrence of bleed from DV.

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“…Bosch et al [10] Mesenteric vein thrombosis EVL Stable (11 mo) Goetz et al [11] Post-trauma splenectomy EVL Stable (4 mo) Gunnerson et al [4] Crush injury EVL Stable (2 yr) Gunnerson et al [4] Anomalous venous vasculature EVL Re-bleed (8 mo) EIS; (Sod mon) Cottam et al [12] Multiple surgical procedures EIS; (Epi) Re-bleed (wk) Surgery Osaka et al [13] Vascular malformation EIS; (Eth) Re-bleed (unknown) Surgery Tsuji et al [14] Motor vehicle accident EIS; (Polid, Throm) Stable (unknown) Surgery Sans et al [15] Caroli's Dz, SMV thrombosis EIS; (Thromb, Eth) Stable (5 mo) Kao et al [16] Pancreatitis; portal vein stenosis EIS; (Cyano, Lip) Stable (2 mo) …”

Section: Ref Etiology/clinical History Intervention Outcome Additionalmentioning

confidence: 99%

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

Steevens

Abdalla

Kothari

et al. 2015

WJGPT

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Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

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Duodenal variceal bleeding caused by chronic pancreatitis

Cited by 3 publications

References 3 publications

Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate for gastrointestinal varices

Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate for gastrointestinal varices

Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

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