Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

Abstract

Background/Aims: Duodenal varices (DV) are ectopic varices which can cause massive gastrointestinal bleeding. The diagnosis of DV may be difficult; sometimes they can be hidden behind duodenal folds. The aim of the study was to evaluate DV by endoscopic ultrasound. Methods: Endoscopic ultrasound was done in patients detected or suspected to be having DV. The para duodenal varices were identified and subsequently hemodynamic evaluation of DV was done. Results: Endoscopic ultrasound identified perforators in seven cases of DV. Conclusion: The endoscopic ultrasound can help in detection of DV underlying thickened folds. It can also help in hemodynamic evaluation of DV. ( J CLIN EXP HEPATOL 2012;2:229-237)

Hemorrhagic Shock from a Duodenal Ulcer Eroding into an Ectopic Varix

“…Ectopic varices located in the duodenum are rare but when bleeding occurs, it is often life-threatening [ 1 ]. Identification of duodenal varices (DV) as the source of bleeding requires thorough examination of the duodenal bulb and 2 nd through 4 th parts of the duodenum with serial endoscopies [ 2 ]. Endoscopy has been shown to be effective in identifying DV in only 44% of cases, and thus there is need for additional diagnostic modalities [ 2 ].…”

“…Due to their small diameter and deep location, DV pose a diagnostic challenge endoscopically. They may initially present as thickened duodenal folds with increasing prominence closer to bleeding [ 2 ]. In patients with cirrhosis, classification of the bleeding source is further complicated by the additional risk of non-variceal bleeding most commonly due to peptic ulcer disease [ 2 ].…”

“…They may initially present as thickened duodenal folds with increasing prominence closer to bleeding [ 2 ]. In patients with cirrhosis, classification of the bleeding source is further complicated by the additional risk of non-variceal bleeding most commonly due to peptic ulcer disease [ 2 ]. Given its anatomic location, the gastroduodenal artery is the vessel typically associated with bleeding from posterior wall duodenal bulb ulcers [ 3 ].…”

The Role of Endoscopic Ultrasound in Hepatology

“…[53][54][55][56] EUS-Doppler was shown to detect gastric and esophageal varices with high sensitivity, and it was also shown to be valuable in evaluating ectopic duodenal varices. [57][58][59][60][61][62][63][64] In addition, EUS is also beneficial in predicting the risk of variceal recurrence after sclerotherapy or band ligation. A study of 38 patients who underwent sclerotherapy for esophageal varices and followed up for 2 years with EUS, reported that EUS could predict variceal recurrence risk as early as 3 to 4 months in advance.…”

The role of EUS in diagnosis and treatment of liver disorders

“…It is also a useful modality for evaluating ectopic duodenal varices 86 87 88 89 90 . The higher the grade of esophageal varices, the higher the EUS sensitivity 82 .…”