Are Downhill Varices an Overlooked Entity of Upper Gastrointestinal Bleedings?

M A Ayvaz,H D Allescher,H Rakici

doi:10.1155/2018/7638496

Abstract

Aim Downhill varices are not so safe as thought and can lead to life-threating or mortal bleeding complication, even if rare. In order to draw attention to this topic, we analysed 129 patients. Materials and Methods We evaluated the electronic endoscopy data records of all patients undergoing upper gastrointestinal endoscopy over a nine-year period from January 2004 till December 2012, within a retrospective approach. The primary endpoints, incidence, causes, kind of resulting upper gastrointestinal bleeding, and the severity of the bleeding were evaluated. Secondary endpoints were the evaluation of the size of downhill varices and a comparison of the risk of bleeding between downhill varices and uphill varices. Results Downhill varices were identified, described, and/or documented in 129 patients of 25,680 upper gastrointestinal endoscopies. 26 patients had central venous catheter or port implantation, 22 patients had a history of an implantation of a cardiac pacemaker, 7 patients had severe pulmonary artery embolism, and 4 patients had severe chronic obstructive pulmonary disease. Two patients had mediastinal tumors, and one patient had a large retrosternal goiter as a possible cause of the vena cava syndrome. Altogether, 62 patients were related to a vena cava superior syndrome; 67 were not. Conclusions Downhill varices can be seen with an incidence of 0.5%. Therapeutic means are the banding therapy as a safe and effective option. Severe bleedings associated with downhill varices can be mortal. Severe forms of downhill varices should be examined in relation to the origin in order to start a specific therapy.

Highlights

The first description of the esophageal varices located in the upper third of the esophagus without the existence of a portal hypertension was in 1964 by Felson and Lessure [1]
We evaluated in a retrospective approach the electronic endoscopy data records of all patients undergoing upper gastrointestinal endoscopy over a nineyear period from January 2004 till December 2012
We identified all published manuscripts and case reports on downhill varices with the keyword downhill varices and upper esophageal varices

Summary

Introduction

The first description of the esophageal varices located in the upper third of the esophagus without the existence of a portal hypertension was in 1964 by Felson and Lessure [1]. Reports in the literature focusing downhill varices are mainly based on case reports and small series of cases. Downhill varices in the upper third of the esophagus occur as a consequence or increase of pressure in the vena cava superior or due to obstruction of the superior vena cava. Type III varices extend over more than 2 cm and fill more than one-third of the lumen (Table 1).

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