Endoscopic Detection and Management of Esophagogastric Varices

Abstract

IntroductionGastrointestinal (GI) varices are abnormally dilated submucosal veins in the digestive tract caused due to portal hypertension. Esophagus and stomach are common locations of varices induced by portal hypertension. Their presence correlates with the severity of the liver disease. Endoscopic variceal band ligation is one of the preferred methods for bleeding and nonbleeding large varices to decrease bleeding risk. Tissue adhesives such as N-butyl-2-cyanoacrylate have been used for gastric variceal obturation. MethodsThis descriptive study was conducted in the Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal, from March 2014 to January 2020. The endoscopic detection of esophageal and gastric varices was observed. Endoscopic variceal ligation (EVL) was done for esophageal varices and injection of N-butyl 2-cyanoacrylate for gastric varices. ResultsEsopahageal varices were detected in 1266 patients (8%) and gastric varices were in 36 patients (0.2%) among 15,657 patients undergoing upper gastrointestinal (UGI) endoscopy. Nine hundred seven (71.6%) were male. Large esophageal varices were endoscopically detected in 54.8% patients, small varices in 31.4% and both (large and small varices) in 13.4%. EVL was done in 30.7% and EVL with cyanoacrylate glue injection in 35 patients (2.7%). ConclusionEsophageal and gastric varices are seen commonly in patients with chronic liver disease. This study was conducted to describe the different types of GI varices in patients undergoing UGI endoscopy. Variceal band ligation for esophageal varices and glue injection for gastric varices are viable options of management.

Predictors of Re-Bleeding After Oesophageal Variceal Banding in Cirrhotic Patients at 4 Weeks

“…14,15 However, this treatment is mostly performed in the in-patient setting and has a high recurrence rate, also needs advanced technique and incurs high cost. 16,17 In this study, the risk of re-bleeding following successful control of the initial bleeding episode with band ligation was observed in 9 (9.7%) patients which is quite low in frequency as compared to the study done by Abbasi A et al, i.e., 19.1% 18 and the difference in frequency is because they included every patient with an indication for band ligation but in this study, we excluded the patients with previous band ligation, portal vein thrombosis and noncirrhotic portal hypertension.…”

The Utility of the Platelet-Albumin-Bilirubin Score as a Non-invasive Predictor of Esophageal Varices and Variceal Hemorrhage in Patients With Liver Cirrhosis Compared to Child-Turcotte-Pugh and Model of End-Stage Liver Disease-Sodium Scores

“…Timely diagnosis of gastro-esophageal varices is vital to prevent upper gastrointestinal (GI) bleed and upper GI endoscopy is the gold standard for diagnosis and treatment [ 9 , 10 ]. In specialized centers, upper GI endoscopies are routinely performed for screening purposes and post-hemorrhage therapeutic management once liver cirrhosis or portal hypertension is established.…”