Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.D...Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.展开更多
Gastric varices(GVs)are notorious to bleed massively and often difficult to manage with conventional techniques.This mini-review addresses endoscopic management principles for gastric variceal bleeding,including limit...Gastric varices(GVs)are notorious to bleed massively and often difficult to manage with conventional techniques.This mini-review addresses endoscopic management principles for gastric variceal bleeding,including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration.The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis,improved classification,innovative management strategies and confirmatory tool for eradication of GVs.展开更多
Gastric varices are usually associated with a gastrorenal(G-R) shunt.However,the gastric varices described in this case report were not associated with a G-R shunt.The inflow vessel was the posterior gastric vein and... Gastric varices are usually associated with a gastrorenal(G-R) shunt.However,the gastric varices described in this case report were not associated with a G-R shunt.The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein.First,percutaneous transhepatic obliteration of the posterior gastric vein was performed,but the gastric varices remained patent.Then,micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein,pericardial vein and cardio-phrenic vein,however,micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment.Thereafter,as a gastrosubphrenic-intercostal vein shunt developed,a microballoon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration(BRTO) was performed resulting in the eradication of gastric varices.BRTO for gastric varices via the intercostal vein has not previously been documented.展开更多
A 76-year-old woman with hepatitis C cirrhosis presented with tarry stools and hematemesis.An endoscopy demonstrated bleeding duodenal varices in the second portion of the duodenum.Contrast-enhanced computed tomograph...A 76-year-old woman with hepatitis C cirrhosis presented with tarry stools and hematemesis.An endoscopy demonstrated bleeding duodenal varices in the second portion of the duodenum.Contrast-enhanced computed tomography revealed markedly tortuous varices around the wall in the duodenum.Several afferent veins appeared to have developed,and the right ovarian vein draining into the inferior vena cava was detected as an efferent vein.Balloon-occluded retrograde transvenous obliteration (BRTO) of the varices using cyanoacrylate was successfully performed in combination with the temporary occlusion of the portal vein.Although no previous publications have used cyanoacrylate as an embolic agent for BRTO to control bleeding duodenal varices,this strategy can be considered as an alternative procedure to conventional BRTO using ethanolamine oleate when numerous afferent vessels that cannot be embolized are present.展开更多
Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. Colonic variceal bleeding remains a rare cause of lower gas...Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. Colonic variceal bleeding remains a rare cause of lower gastrointestinal tract (GI) bleeding. Due to the paucity of cases, there are no well-established conventional treatments for bleeding colonic varices. Different treatments have been reported. Here, we report a case of a 55-year-old gentleman, with a history of alcoholic liver cirrhosis, presenting with severe lower GI bleeding and symptomatic anaemia. An esophagogastroduodenoscopy revealed large esophageal varices with high-risk bleeding stigmata requiring endoscopic variceal ligation. A cross-sectional computed tomography scan showed colonic portosystemic shunts. In light of this and that the severe lower GI bleeding seemed out of proportion to the esophageal varices seen on upper endoscopy, an urgent unprepped colonoscopy was performed which revealed possible bleeding diverticula disease which required endoscopic mechanical hemoclip therapy. However, despite this, patient had recurrence of lower GI bleeding prompting a second colonoscopy. This relook colonoscopy showed ectopic ascending colon varices with high-risk bleeding stigmata. High-dose intravenous vasoactive agent somatostatin (500 mcg/hour) and subsequently terlipressin (2 mg every 4 hours) were used. The patient subsequently underwent successful balloon-occluded retrograde transvenous obliteration (B-RTO) and sclerotherapy. The non-selective beta-blocker (NSBB) carvedilol was started and bridged together with the vasoactive agent until stabilisation of portal hypertension. This difficult case illustrates the dynamic nature of portal hypertensive bleeding. It also highlights the presence of confounding non-variceal pathology complicating diagnosis of portal hypertensive colonic variceal bleeding, and that ectopic ascending colonic variceal bleeding can be treated successfully with B-RTO and sclerotherapy, with meticulous titration of high-dos展开更多
AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric vari...AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.展开更多
文摘Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.
文摘Gastric varices(GVs)are notorious to bleed massively and often difficult to manage with conventional techniques.This mini-review addresses endoscopic management principles for gastric variceal bleeding,including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration.The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis,improved classification,innovative management strategies and confirmatory tool for eradication of GVs.
文摘 Gastric varices are usually associated with a gastrorenal(G-R) shunt.However,the gastric varices described in this case report were not associated with a G-R shunt.The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein.First,percutaneous transhepatic obliteration of the posterior gastric vein was performed,but the gastric varices remained patent.Then,micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein,pericardial vein and cardio-phrenic vein,however,micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment.Thereafter,as a gastrosubphrenic-intercostal vein shunt developed,a microballoon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration(BRTO) was performed resulting in the eradication of gastric varices.BRTO for gastric varices via the intercostal vein has not previously been documented.
文摘A 76-year-old woman with hepatitis C cirrhosis presented with tarry stools and hematemesis.An endoscopy demonstrated bleeding duodenal varices in the second portion of the duodenum.Contrast-enhanced computed tomography revealed markedly tortuous varices around the wall in the duodenum.Several afferent veins appeared to have developed,and the right ovarian vein draining into the inferior vena cava was detected as an efferent vein.Balloon-occluded retrograde transvenous obliteration (BRTO) of the varices using cyanoacrylate was successfully performed in combination with the temporary occlusion of the portal vein.Although no previous publications have used cyanoacrylate as an embolic agent for BRTO to control bleeding duodenal varices,this strategy can be considered as an alternative procedure to conventional BRTO using ethanolamine oleate when numerous afferent vessels that cannot be embolized are present.
文摘Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. Colonic variceal bleeding remains a rare cause of lower gastrointestinal tract (GI) bleeding. Due to the paucity of cases, there are no well-established conventional treatments for bleeding colonic varices. Different treatments have been reported. Here, we report a case of a 55-year-old gentleman, with a history of alcoholic liver cirrhosis, presenting with severe lower GI bleeding and symptomatic anaemia. An esophagogastroduodenoscopy revealed large esophageal varices with high-risk bleeding stigmata requiring endoscopic variceal ligation. A cross-sectional computed tomography scan showed colonic portosystemic shunts. In light of this and that the severe lower GI bleeding seemed out of proportion to the esophageal varices seen on upper endoscopy, an urgent unprepped colonoscopy was performed which revealed possible bleeding diverticula disease which required endoscopic mechanical hemoclip therapy. However, despite this, patient had recurrence of lower GI bleeding prompting a second colonoscopy. This relook colonoscopy showed ectopic ascending colon varices with high-risk bleeding stigmata. High-dose intravenous vasoactive agent somatostatin (500 mcg/hour) and subsequently terlipressin (2 mg every 4 hours) were used. The patient subsequently underwent successful balloon-occluded retrograde transvenous obliteration (B-RTO) and sclerotherapy. The non-selective beta-blocker (NSBB) carvedilol was started and bridged together with the vasoactive agent until stabilisation of portal hypertension. This difficult case illustrates the dynamic nature of portal hypertensive bleeding. It also highlights the presence of confounding non-variceal pathology complicating diagnosis of portal hypertensive colonic variceal bleeding, and that ectopic ascending colonic variceal bleeding can be treated successfully with B-RTO and sclerotherapy, with meticulous titration of high-dos
文摘AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.
