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

Wan, Yipeng; Liu, Cong; Wan, Sizhe; Chenkai, Huang; Wang, Anjiang; Zhu, Xuan

doi:10.1097/meg.0000000000001819

Cited by 14 publications

(14 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We previously performed a systematic review of all published evidence to evaluate the effectiveness and safety of endoscopic treatments for DV bleeding and found that the rates of rebleeding and mortality following endoscopic treatment for DV bleeding were 8.9% and 13.9%, respectively. [ 48 ] This discrepancy may be associated with the variable definition of “rebleeding” in the published literature and a publication bias in this systematic review. Overall, endoscopic treatment is an effective option for controlling EcV bleeding, but the long-term efficacy may be poor.…”

Section: Discussionmentioning

confidence: 90%

“…However, the aforementioned a systematic review showed that endoscopic tissue adhesive injection may be preferable in the management of DV bleeding. [ 48 ] Given the small number of patients in our study, prospective controlled studies with large sample sizes are required to compare the efficacy and safety of different endoscopic treatments for EcV bleeding.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices

Wan¹,

Wang²,

Li³

et al. 2021

Saudi Journal of Gastroenterology

Self Cite

View full text Add to dashboard Cite

Background: Ectopic varices (EcVs) may cause massive bleeding, which can be difficult to control, with a high rate of mortality. The purpose of this study was to analyze the clinical characteristics of EcVs and the efficacy of endoscopic treatment. Methods: From January 2008 to July 2017, the clinical data of 150 patients with EcVs in our center were retrospectively collected and analyzed. Results: One hundred and fifty patients with EcVs (male 74.7%), with a mean age of: 54.1 ± 14.6 years were included. The prevalence of EcVs was 0.92% in gastrointestinal varices. Cirrhosis was the most common cause of EcVs (67.0%). The rates of bleeding were 57.14%, 4.34%, 30.0%, 33.3%, and 100% in the duodenal varices rectal varices, colonic varices, anastomotic varices, and small bowel varices, respectively. An age under 55 years, varices in the duodenum, and erythema were considered risk factors for EcV bleeding. Endoscopic treatments were performed in 15 patients with EcV bleeding. The follow-up period of the patients who underwent endoscopic treatment ranged from 0.5 to 24 months. The overall rate of treatment success was 73.33% for endoscopic treatment of EcV bleeding. The overall rates of rebleeding and mortality during 2 years were as high as 53.3% and 26.7%, respectively. Conclusion: Age, erythema, and the location of EcVs are considered risk factors for EcV bleeding, and the rate of bleeding is higher in patients with duodenal varices than in those with other EcVs. Endoscopic treatment is safe, effective, and feasible for controlling EcV bleeding.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices

Wan¹,

Wang²,

Li³

et al. 2021

Saudi Journal of Gastroenterology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thus far, no treatment strategies for duodenal varices have been established. Recently, Wan et al reported the safety, simplicity and rapidity of EIS for bleeding duodenal varices compared to surgical procedures and interventional radiology (8,9,26,27). Ineffectiveness or rebleeding can be expected in endoscopic variceal ligation for duodenal varices rupture (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Duodenal Variceal Rupture during Atezolizumab and Bevacizumab Treatment for Hepatocellular Carcinoma

et al. 2023

View full text Add to dashboard Cite

Duodenal varices are detected infrequently, and their rupture is very rare. We encountered an 87-year-old man who developed duodenal varices rupture during chemotherapy with atezolizumab and bevacizumab (ATZ/BV) for hepatocellular carcinoma. We identified massive bleeding of a ruptured varix in the horizontal portion of the duodenum with emergency esophagogastroduodenoscopy (EGD). Successful hemostasis was achieved by endoscopic injection sclerotherapy with Histoacryl. Although ATZ/BV can cause esophageal varices rupture, there have been no cases of duodenal varices rupture. We should take care to check the duodenal varices as well as esophagogastric varices before ATZ/BV treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The high rate of rebleeding (19.04%) in our study could be related to the severity of underlying liver disease as patients with advanced cirrhosis are more likely to present with rebleeds. 18 Western data have shown that ectopic varices are more frequently noted in the duodenal bulb, while a Japanese study reported that the most common site of occurrence of DV was the descending duodenum. 4,19 In our own study, DVs were most common in the duodenal bulb and were seen in 21 patients, followed by second part of duodenum in 17 patients, while 3 patients had varices in the third part of duodenum.…”

Section: Esophageal Varices 13mentioning

confidence: 98%

Endoscopic Cyanoacrylate Glue Injection for Duodenal Varices—A Single-Center Study

Shafiq

Devarbhavi

Patil

2022

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Aim/Objectives Duodenal varices (DVs), although rare, can present with massive, potentially fatal upper gastrointestinal bleeding; however, there are no randomized trials regarding management of this relatively uncommon presentation. We aim to report our experience with endoscopic cyanoacrylate glue injection in patients with DVs. Materials and Methods We retrospectively evaluated the medical records of all patients with portal hypertension at our center between January 2010 and December 2021. Demographic characteristics along with the etiology, location, and effectiveness of cyanoacrylate glue injection for bleeding DVs were collected and analyzed. Results A total of 5,892 patients with portal hypertension underwent endoscopy during the study period, of whom 41 patients (M:F = 29:12) with mean age of 38 years were noted to have DVs. While extrahepatic portal vein obstruction was the commonest etiology (n = 26), the most common site of DVs was the duodenal bulb (n = 21). Twenty-one (51%) out of these 41 patients presented primarily with DV bleeding and underwent endoscopic cyanoacrylate glue injection with successful hemostasis achieved of the index bleed; however, four of these 21 patients had rebleeding between 2 weeks and 12 months of follow-up requiring repeat endotherapy.. While three patients underwent successful repeat glue injections, one patient had recurrent massive bleedings, not amenable to endotherapy and was subjected to duodenal resection with surgical shunt procedure. Conclusion While the prevalence of DVs in portal hypertension patients was 0.7% (41/5892), DVs accounted for 0.42% (21/4889) of portal hypertension-related bleedings. Endotherapy with cyanoacrylate glue appears to be a safe and cost-effective treatment for acute DV bleeding in a resource-limited setting.

show abstract

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

Abstract: Supplemental Digital Content is available in the text.

Cited by 14 publications

References 57 publications

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices

Duodenal Variceal Rupture during Atezolizumab and Bevacizumab Treatment for Hepatocellular Carcinoma

Endoscopic Cyanoacrylate Glue Injection for Duodenal Varices—A Single-Center Study

Contact Info

Product

Resources

About