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

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

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Papers

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

Metastatic malignant melanoma of the papilla of Vater: an unusual case of obstructive cholestasis treated with biliary prostheses.

Life-threatening hemorrhage: an unusual form of presentation of Crohn's disease treated with endoscopic injection sclerotherapy.

Polypectomy in giant inflammatory pseudopolyposis.