Endoscopic ultrasonographic evaluation of the rectum in cirrhotic portal hypertension

Dhiman, Radha K.; Choudhuri, Gourdas; Saraswat, Vivek A.; Mukhopadhyay, D.; Khan, Enam Murshed; Pandey, Rakesh; Naik, S. R.

doi:10.1016/s0016-5107(93)70214-x

Cited by 31 publications

(29 citation statements)

References 22 publications

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“…Rectal varices occur much more commonly in patients with portal hypertension (especially those that have undergone sclerotherapy of esophageal varices), but hemorrhoids occur no more commonly in cirrhotics than in age-matched controls [77]. Diagnosis is usually made endoscopically but can also be made with endoscopic ultrasound with or without color Doppler [85][86][87]. Even transvaginal sonography has been used to diagnose rectal varices [88].…”

Section: Colorectal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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Section: Colorectal Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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“…Conventional EUS has been demonstrated to be a useful modality for the hemodynamic diagnosis and evaluation of anorectal varices in both children [27] and adults [28,29]. Indeed, EUS has been shown to be superior to endoscopy in detecting the presence and number of rectal varices [25].…”

Section: Endoscopic Ultrasound (Eus)mentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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Purpose of Review The purpose of this review is to summarize available strategies for the diagnosis and management of bleeding anorectal varices. Recent Findings Interventional radiological procedures, including TIPS, BRTO and/or embolization, have been established as efficacious treatments, particularly in the setting of treatment failure. Summary Anorectal varices are prevalent in patients with portal hypertension. Acute bleeding is uncommon, but can be massive and life-threatening. Anorectal varices should be considered as a differential diagnosis in any patient with cirrhosis or portal hypertension who presents with lower gastrointestinal bleeding. No evidence-based guidelines exist to guide the management of bleeding anorectal varices, which typically requires a multidisciplinary team of endoscopists, hepatologists, surgeons and interventional radiologists. Administration of prophylactic antibiotics and vasoactive therapy is recommended based on efficacy in bleeding oesophageal varices. Urgent endoscopy should be performed in all patients. Endoscopic sclerotherapy has the greatest body of evidence and should be considered the first-line therapy; efficacy and safety may be increased if this is performed with endoscopic ultrasound. Endoscopic banding or obturation are alternative first-line treatments; all methods offer a technically simple and efficacious method of achieving haemostasis, and local expertise will determine which procedure is employed.

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“…EUS can detect deep rectal varices in a large proportion of patients who do not have identified varices on routine endoscopy [17] . Dhiman et al [18] showed that EUS is better than endoscopy in detecting rectal varices (85% vs 45%) and in determining their number. Sato et al [19] demonstrated that intramural rectal varices, perirectal collateral veins, and the communicating veins between intramural rectal varices and perirectal collateral veins could be observed clearly with an ultrasonic microprobe.…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%