Bleeding ectopic varices—treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation

Ectopic varices (EcV) comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. No large series or randomized-controlled trials address this subject, and therefore its management is based on available expertise and facilities, and may require a multidisciplinary team approach. EcV are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1–5% of all variceal bleeding. EcV develop secondary to portal hypertension (PHT), surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial in origin. Bleeding EcV may present with anaemia, shock, haematemesis, melaena or haematochezia and should be considered in patients with PHT and gastrointestinal bleeding or anaemia of obscure origin. EcV may be discovered during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, colour Doppler-flow imaging, laparotomy, laparoscopy and occasionally during autopsy. Patients with suspected EcV bleeding need immediate assessment, resuscitation, haemodynamic stabilization and referral to specialist centres. Management of EcV involves medical, endoscopic, interventional radiological and surgical modalities depending on patients’ condition, site of varices, available expertise and patients’ subsequent management plan.

/pdf/updates-in-the-pathogenesis-diagnosis-and-management-of-1omgtakjpe.pdf

Updates in the pathogenesis, diagnosis and management of ectopic varices

https://www.techvir.com/article/S1089-2516(13)00025-5/pdf

Ectopic Varices: Anatomical Classification, Hemodynamic Classification, and Hemodynamic-Based Management

SUMMARY Background Bleeding from ectopic varices is uncommon but can be difficult to manage. Aim To report our experience of the use of transjugular intrahepatic portosystemic stent shunts (TIPSS) in the management of uncontrolled bleeding from ectopic varices. Methods A retrospective study of patients who had TIPSS for bleeding ectopic varices. Patients were selected from a dedicated data base. Results

Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts

Ectopic varices: Ectopic Varices

/pdf/thrombin-and-ethanolamine-injection-therapy-in-arresting-1r8lxa7mwg.pdf

Thrombin and ethanolamine injection therapy in arresting uncontrolled bleeding from duodenal varices

BACKGROUND/AIMS: In 20-50% of patients bleeding from esophageal varices, conservative procedures fail to obtain hemostasis and prevent early recurrence. METHODOLOGY: We retrospectively analyzed the efficacy and safety of endoscopic sclerotherapy in 66 cirrhotic patients with high surgical risk and persistence or recurrence of variceal bleeding in spite of adequate medical treatment (somatostatin and/or balloon tamponade). RESULTS: Emergency sclerosis controlled bleeding in 46 out of 66 patients (70%). The remaining 20 patients underwent additional procedures to arrest the hemorrhage, and 6 died because of massive bleeding. Early rebleeding occurred in 5 patients (10%). The mortality within 2 days, 1 week, and 6 weeks was 9%, 17% and 32%, respectively. Death was attributed to hemorrhage in 9 cases. Sclerotherapy was associated with complications in 9 patients (14%). CONCLUSION: These results suggest that emergency sclerotherapy is a safe and effective procedure in cirrhotic patients with high surgical risk and persistence or recurrence of bleeding after conservative hemostatic procedures.

Endoscopic sclerotherapy to arrest uncontrolled variceal bleeding in cirrhotic patients with high surgical risk.

/pdf/duodenal-variceal-bleeding-treated-with-a-transjugular-4i9s65py81.pdf

Duodenal variceal bleeding treated with a transjugular intrahepatic portosystemic shunt

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Papers

Thrombin and ethanolamine injection therapy in arresting uncontrolled bleeding from duodenal varices

Endoscopic sclerotherapy to arrest uncontrolled variceal bleeding in cirrhotic patients with high surgical risk.

Duodenal variceal bleeding treated with a transjugular intrahepatic portosystemic shunt