Percutaneous Retrograde Sclerotherapy for Refractory Bleeding of Jejunal Varices: Direct Injection via Superficial Epigastric Vein

Nakata, Manabu; Nakata, Waka; Isoda, Norio; Yoshizawa, Mitsuyo; Sugimoto, Hideharu

doi:10.1007/s00270-011-0165-3

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…The selection of possible therapeutic options is made considering the risks and benefits based on the site of the varices, patient’s condition, doctor’s experience, and the capability of the facility [ 15 ]. Therapeutic options for bleeding ectopic varices include local treatment for the varices and portal decompression [ 16 ]. Local treatment for the varices comprise endoscopic sclerotherapy, endoscopic variceal band ligation, endoclips, percutaneous transhepatic obliteration, and balloon-occluded retrograde transvenous obliteration.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Lee

Huang

2018

Medicina

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Jejunal varices are a rare manifestation of portal hypertension, and they are associated with a high mortality and poor prognosis when bleeding occurs. A bleeding jejunal varix is much more challenging to diagnose and manage because of its anatomic location. Herein, we describe the case of a 62-year-old man with active jejunal variceal bleeding who presented with massive hematochezia and hypovolemic shock. He was treated successfully with a high volume and concentration of a glue mixture as endoscopic sclerotherapy using single-balloon enteroscopy in the intensive care unit. Enteroscopic sclerotherapy is an effective option for jejunal variceal bleeding.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Lee

Huang

2018

Medicina

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“…El tratamiento endoluminal se ha descrito para el control del sangrado las asas de nailon (miniloops) que permiten ligar la várice, y también se han instilado directamente a la VE el cianoacrilato con controles temporales del sangrado (37,38).…”

Section: Tratamiento De Las Várices Ectópicas (Ve)unclassified

Várices ectópicas en yeyuno proximal asociadas a sangrado recurrente en paciente sin cirrosis hepática

Peñaloza

Sánchez²

2014

Rev Colomb Gastroenterol

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Las várices ectópicas (VE) en yeyuno son alteraciones vasculares infrecuentes, asociadas en mayor medida a la hipertensión portal (5%). Cuando se presenta sin esta asociación son aún menos frecuentes. Presentamos un caso de sangrado crónico intestinal de varios años, sin hipertensión portal proveniente de várices localizadas en yeyuno proximal, su curso clínico, los elementos de diagnóstico empleados y terapia quirúrgica.

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“…Even with a micropuncture set, however, percu taneous access may be challenging (Fig 13). Mi nami et al (74) have reported a cutdown technique for access to the left superficial epigastric vein to perform BRTO for stomal varices, and Nakata et al (75) have recently used a similar access route for sclerotherapy of jejunal varices. If a sclerosant is used, fluoroscopy-guided compression over drainage veins can decrease early outflow into the systemic system.…”

Section: Ectopic Varices: Percutaneous Access and Sclerotherapymentioning

confidence: 99%

Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success

Kirby¹,

Cho²,

Midia³

2013

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Management of clinically important sequelae of portal hypertension, such as variceal bleeding and ascites, may involve a combination of medical, endoscopic, surgical, and interventional approaches and procedures. Although clinically significant esophageal and rectal varices are typically visible endoscopically, ectopic varices may require multiplanar portal venous phase computed tomography or magnetic resonance imaging for diagnosis. A detailed understanding of individual vascular anatomy, flow dynamics, and patient-related factors such as cardiac and hepatic status is necessary for appropriate treatment selection in patients with complicated portal hypertension. The hepatic venous pressure gradient is the key indirect measurement of portal venous pressure. Transjugular intrahepatic portosystemic shunt (TIPS) placement is regarded as the archetypal intervention for treating complicated portal hypertension by reducing portal pressure. Various modifications, such as direct portocaval shunt, may be used in patients with challenging vascular anatomy. A subset of patients with obstructed hepatic venous outflow or portal venous inflow should be considered for recanalization. Splenic artery embolization may be considered for reduction of portal pressure in selected patients, particularly when hypersplenism or splenic vein occlusion is a prominent feature. Gastric and ectopic varices may bleed even when the portal pressure is low, and balloon-occluded retrograde transvenous obliteration (BRTO) in such patients may lead to equal or improved outcome compared with TIPS placement. BRTO is not limited by poor hepatic reserve or encephalopathy; however, it does not reduce portal pressure and may aggravate esophageal varices. Interventional radiology plays an important role in maintaining the patency of surgically created portosystemic shunts, and it remains at the forefront of new approaches in shunt design and placement. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125166/-/DC1.

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Percutaneous Retrograde Sclerotherapy for Refractory Bleeding of Jejunal Varices: Direct Injection via Superficial Epigastric Vein

Cited by 4 publications

References 10 publications

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Várices ectópicas en yeyuno proximal asociadas a sangrado recurrente en paciente sin cirrosis hepática

Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success

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