Gastric Fundal Varices Research Articles

Duodenal Varices: A Rare Manifestation of Portal Hypertension

Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleed. The etiology of duodenal varices can be classified into hepatic (e.g. cirrhosis) or extra hepatic (e.g. portal, splenic or superior mesenteric vein thrombosis). Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely accepted as primary therapies for esophageal variceal bleeding whereas bleeding gastric fundal varices are usually treated with cyanoacrylate injection or shunt procedures. However there is no widely accepted treatment modality for duodenal varices.

Pediatric gastroesophageal varices: treatment strategy and long-term results

Background/Purpose There are various treatment strategies for gastroesophageal varices in children. We studied the therapeutic value of endoscopic variceal clipping (EVC) and ligation (EVL). Methods Four hundred ninety-nine endoscopic examinations performed between 1991 and 2005 were retrospectively analyzed. F2 and F3 varices with red color signs on follow-up endoscopy were treated with prophylactic EVC. In variceal rupture cases, EVC and EVL were used in combination. Results Eighty-two prophylactic EVCs were done, and variceal progression was prevented in 89.9%. However, some patients had persistent red color signs and required frequent EVC. Ten emergent procedures were done for variceal rupture, and, in 4 cases, EVL was used to arrest massive variceal bleeding. Five patients developed bleeding during follow-up cause by rupture of gastric fundal varices, which probably had been aggravated by prior treatment for esophageal varices. Conclusions The control of gastroesophageal varices by routine EVC was satisfactory. However, ruptures during follow-up suggested the importance of controlling gastric fundal varices. Endoscopic variceal ligation is a simple, effective, and safe treatment tool, particularly for ruptured varices. However, it is difficult to treat gastric fundal varices with EVL; this disadvantage of EVL can be overcome by the concomitant use of EVC.

Cyanoacrylate in the treatment of gastric varices complicated by multiple pulmonary emboli

Bleeding gastric varices are increasingly being obliterated with the aid of endoscopic injection of n-butyl-cyanoacrylate (histoacryl) diluted with lipiodol. This glue acts as a tissue adhesive that polymerizes on contact with blood in a gastric varix. Severe glue pulmonary embolism is a rare complication of injection therapy. This case involves a 52-year-old man with fundal gastric varices, who developed multiple pulmonary emboli following glue injection with profound hypoxia requiring hospital admission for 13 days, but with eventual recovery of normal lung function.

Report of 8 cases of left-sided extrahepatic portal hypertension

目的 总结胰源性左侧肝外门静脉高压症(LEPH)临床特点、诊断和治疗经验.方法回顾性分析我院收治的8例LEPH病人临床资料.结果LEPH主要表现为黑便、呕血和脾肿大、脾功能亢进,并有胰腺炎、胰腺肿瘤或胰腺外伤表现,而无肝脏疾病表现,内镜下以孤立性胃底静脉曲张为主.术前易误诊为肝硬化门脉高压症.本组病例中行单纯脾切除2例,脾切除+胰体尾切除术5例,脾动脉结扎1例.结论胰腺疾病可致门静脉高压症,脾静脉栓塞是本病直接原因.胰腺疾病合并上消化道出血应想到本症可能,脾切除术可有效控制出血。

Management of Bleeding Gastric Varices with Histoacryl Glue Injection - Long-Term Outcomes

Management of Bleeding Gastric Varices with Histoacryl Glue Injection Long-Term Outcomes Jaber Al Ali, Justin Cheung, Michael Byrne, Scott Whittaker, Urs Stienbreacher, Robert Enns Gastric variceal bleeding is an uncommon life threatening complication of portal hypertension. The management of this complication has not been standardized; however, transjugular intrahepatic portosystemic shunt (TIPS) is widely used in the many centers. Endoscopic treatment with histoacryl glue is another treatment option that can be performed acutely in many endoscopy clinics. As we developed experience with ‘glue’ injection of fundal varices we were unclear of the long term benefit and hypothesized that many of these patients may be dying of other causes. We reviewed our long-term outcomes to determine survival and benefit of histoacryl injection therapy of fundal varices. Methods: A retrospective chart review (2001-2005) inclusive of all patients treated with histoacryl glue injection for bleeding gastric fundal varices. Results: 22 patients were treated with histoacryl glue for bleeding gastric varices. Complete data is pending on three patients; therefore analysis was performed on the remaining 19 patients (13 male). A mean of 3 cc was injected in each patient. Repeat endoscopic examination was performed in most patients but repeat injection was deemed necessary in only 3. No patients suffered a complication from the procedure and all injections were successful in cessation of bleeding with no cases of delayed repeat hemorrhage. At follow up median of 24 months 13 (59%) were alive and functioning with minimal limitations. Conclusion: Short term treatment of bleeding fundal varices with glue has been demonstrated to be helpful, however, in this study, long term outcomes of ‘glue’ injection has a favorable survival which strongly supports aggressive use of this endoscopic modality of therapy. Further data is being collected on remaining patients which we feel is likely to support this mode of therapy.

Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices

To evaluate the effect of three interventional treatments involving transvenous obliteration for the treatment of gastric varices, and to compare the efficacy and adverse effects of these methods. From 1995 to 2004, 93 patients with gastric fundal varices underwent interventional radiologic embolotherapy at our hospital. Of the 93 patients, 75 were treated with the balloon-occluded retrograde transvenous obliteration (BRTO) procedure; 8 were with the percutaneous transhepatic obliteration (PTO) procedure; and 10 were with the combined BRTO and PTO therapy. A follow-up evaluation examined the rates of survival, recurrence and rebleeding of the gastric varices, worsening of esophageal varices and complications in each group. The BRTO, PTO, and combined therapy were technically successful in 81% (75/93), 44% (8/18), and 100% (10/10) patients, respectively. Recurrence of gastric varices was found in 3 patients in the BRTO group and in 3 patients in the PTO group. Rebleeding was observed in 1 patient in the BRTO group and in 1 patient in the PTO group. The 1- and 3-year survival rates were 98% and 87% in the patients without hepatocellular carcinoma (HCC) in the BRTO group, 100% and 100% in the PTO group, and 90% and 75% in the combined therapy group, respectively. Combined BRTO and PTO therapy may rescue cases with uncontrollable gastric fundal varices that remained even after treatment with BRTO and/or PTO, though there were limitations of our study, including retrospective nature and discrepancy in sample size between the BRTO, PTO and combined therapy groups.

Gastric fundal varices: new aspects of nonsurgical treatment in Japan

Bleeding from gastric varices is a life-threatening event that presents a therapeutic challenge for clinicians. This Viewpoint discusses the advance in nonsurgical treatment of gastric fundal varices, including the new radiologic technique of balloon-occluded retrograde transvenous obliteration.

Sclerotherapy for gastric fundal variceal bleeding: Is complete obliteration possible without cyanoacrylate?

Many studies have suggested that endoscopic obliteration using cyanoacrylate for bleeding gastric fundal varices is effective. However, serious complications by injection of cyanoacrylate into varices have also been reported. Thirty patients with bleeding gastric fundal varices underwent endoscopic injection sclerotherapy using 5% ethanolamine oleate under fluoroscopic guidance plus infusion of vasopressin and a transdermal nitroglycerin patch. The injection of 5% ethanolamine oleate was continued until it filled the varices and their feeder veins under fluoroscopic guidance. The injection needle was removed while thrombin glue was sprayed at the puncture site through the side hole of the injector needle to prevent bleeding from the puncture site. Complete hemostasis was achieved in 28/30 patients (93.3%). The cumulative rebleeding rate after 1, 3 and 5 years was 13%, 19% and 19%, respectively. The 1-, 3-, and 5-year cumulative mortality rates were 31%, 54% and 59%, respectively. There was no complication related to infusion of vasopressin and sclerotherapy procedure. The sclerotherapy method carried out using 5% ethanolamine oleate combined with infusion of vasopressin under fluoroscopic guidance might be a feasible method for obliteration of gastric fundal varices as an alternative to cyanoacrylate.

Inflammatory tumor in pancreas: a novel complication after endoscopic injection of cyanoacrylate for gastric fundal varices

Inflammatory tumor in pancreas: a novel complication after endoscopic injection of cyanoacrylate for gastric fundal varices

Percutaneous transhepatic catheter embolization for the treatment of esophagogastric varices: clinical application

Objective To evaluate the efficacy of percutaneous transhepatic catheter embolization for the treatment of esophagogastric varices. Methods 30 patients of liver cirrhosis with esophagogastric varices were included this study. Of the 30 patients, 24 suffered from rebleeding after two days to three months of endoscopic legation and sclerotherapy, another 6 patients had no history of endoscopic treatment. All interventional procedures were performed under guiding of fluoroscopy. The catheter was inserted into right or left branches of portal vein by percutaneous puncture. Esophageal and/or gastric varices were embolized with stainless steel coils, ethanol and glutin. Port-catheter system was planted and regional drug infusion into portal vein system was done in two patients after embolization. Results Catheter insertion and embolization of gastric coronal veins were completed in all 30 patients. The success rate of gastric short veins catheterization and embolization was 90%. 27 patients were followed up for 2—18 months. Endoscopic examination was performed in 17 patients and showed that gastric fundal varices were disappeared in 13 patients and alleviated evidently in 4. Rebleeding were occurred in 2 patients after 2 weeks and 2 months, respectively, and the same procedures were performed again and no rebleeding happened in follow-up. The pressure of portal vein declined 10 cm H2O(1 cm H2O=0.098 kPa) and 8 cm H2O respectively in two patients with portal drug infusion treatment. Conclusion Percutaneous transhepatic catheter embolization is a safe, micro-invasive and effective method for the treatment of esophagogastric varices , it should be used as the first choice in treating patients with acute varices hemorrhage. Further investigation of portal vein drug infusion treatment via port-catheter system is needed.

Use of the Curved Linear-Array Echo Endoscope to Identify Gastrorenal Shunts in Patients with Gastric Fundal Varices

We read with interest the article by Kakutani et al. reporting on the value of echo endoscopy for detecting and identifying gastrorenal shunts in patients presenting with gastric fundal varices [1]. The authors note that balloon-occluded retrograde transvenous obliteration has been described as effective in patients with bleeding fundal varices. This treatment modality requires a spontaneously developed gastrorenal shunt as a pathway for the balloon catheter to reach the fundal varices. The authors suggest that the curved linear-array echo endoscope can be used to assess whether a gastrorenal shunt is present, and compared this method with contrast-enhanced computed tomography.

Standardized Injection Technique and Regimen Minimizes Complication and Ensures Safety of N-Butyl-2-Cyanoacrylate Injection for the Treatment of Gastric Fundal Varices

Standardized Injection Technique and Regimen Minimizes Complication and Ensures Safety of N-Butyl-2-Cyanoacrylate Injection for the Treatment of Gastric Fundal Varices

Hemorrhagic shock in a schistosomotic patient submitted to endoscopic biopsy of a gastric fundus varices confused with a polypoid lesion

Hemorrhagic shock in a schistosomotic patient submitted to endoscopic biopsy of a gastric fundus varices confused with a polypoid lesion

Endoscopic management of the liver transplant patient

Endoscopic management of the liver transplant patient

Diagnosis and management of ectopic varices

Abstract Ectopic varices are dilated portosystemic venous collateral vessels that may occur anywhere in the gastrointestinal tract. Ectopic varices account for approximately 5% of all hemorrhages from varices. Ectopic varices may occur as a result of portal hypertension from any cause but are more common (particularly duodenal and biliary varices) in patients with extrahepatic portal vein thrombosis. Ectopic varices may also develop following successful endoscopic obliteration of gastroesophageal varices. With the exception of isolated gastric fundal varices, ectopic varices have relatively low risk for bleeding. Diagnosis is often made by endoscopy; however, computed tomography, magnetic resonance imaging and portal venography may be needed in some cases. Endoscopic treatment is successful in many cases and is the safest option provided bleeding is definitively controlled. Surgical options are now reserved for treatment of life‐threatening bleeding or for shunt insertion in patients who are not candidates for transjugular intrahepatic portosystemic shunt (TIPS) as a result of portal vein thrombosis. Portal decompression using TIPS, in spite of the risk for encephalopathy, is the treatment of choice for bleeding from ectopic varices that cannot be successfully managed endoscopically.

Tissue glue for the endoscopist: Healing by sealing

Tissue glue for the endoscopist: Healing by sealing

Cost-Effective Therapeutic Strategy for the Management of Bleeding Gastric Fundal Varices

We read with great interest the article by Kok et al. on a case of bleeding gastric fundal varices with a fatal outcome [1].

Limitations of Cyanoacrylate Injection for the Treatment of Gastric Fundic Varices: Reply to Matsumoto et al.

Limitations of Cyanoacrylate Injection for the Treatment of Gastric Fundic Varices: Reply to Matsumoto et al.

A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans

Background N-butyl cyanoacrylate injection has been shown to be effective and safe for the endoscopic treatment of gastric varices. N-butyl cyanoacrylate is not available in the United States, but use of a similar agent, 2-octyl cyanoacrylate, recently was approved for skin closure. This pilot study prospectively evaluated the efficacy and safety of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices. Methods Twenty-five patients with large gastric fundal varices with either stigmata of recent hemorrhage, a history of bleeding, or high-risk varices underwent intravariceal injection of undiluted 2-octyl cyanoacrylate. The end points for this study were cessation of active bleeding, successful obliteration of visible varices, and prevention of bleeding. Results Within 2 weeks of treatment, 52% of patients had a history of significant variceal bleeding, and 12% had active gastric variceal bleeding at the time of injection. The rate of immediate hemostasis was 100%. Gastric variceal bleeding recurred in 4% of patients (mean follow-up 11 months). The overall mortality rate was 12%; the bleeding-related mortality rate was 4%. Conclusions Injection of 2-octyl cyanoacrylate appears to be efficacious and safe for both prevention and control of gastric variceal hemorrhage. Larger studies are required to further establish the use of 2-octyl cyanoacrylate for treatment of gastric fundal varices.

Successful balloon-occluded retrograde transvenous obliteration for ruptured gastric fundal varices in a patient with Child-Pugh C cirrhosis: case report and literature review.

Successful balloon-occluded retrograde transvenous obliteration for ruptured gastric fundal varices in a patient with Child-Pugh C cirrhosis: case report and literature review.