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. 2008 Sep;2(3):322-34.
doi: 10.1007/s12072-008-9074-1. Epub 2008 May 31.

Updates in the pathogenesis, diagnosis and management of ectopic varices

Ahmed Helmy  1 , Khalid Al Kahtani, Mohamed Al Fadda
Affiliations

Updates in the pathogenesis, diagnosis and management of ectopic varices

Ahmed Helmy et al. Hepatol Int. 2008 Sep.

Erratum in

  • Errata.
    Omata M, Sarin SK. Omata M, et al. Hepatol Int. 2008 Sep;2(3):395-6. doi: 10.1007/s12072-008-9089-7. Hepatol Int. 2008. PMID: 19669272 Free PMC article. No abstract available.

Abstract

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.

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Figures

Fig. 1
Fig. 1
(a) Upper endoscopy picture showing serpiginous varices in the postbulbar duodenum with a focus on intermittent bleeding. (b) Close-up view
Fig. 2
Fig. 2
Sigmoidoscopy (a, b) and colonoscopy (c) pictures showing dilated venous collaterals and spider angiomas in a patient with liver cirrhosis and PHT
Fig. 3
Fig. 3
Schematic of the management of bleeding EcV. APC, argon plasma coagulation; EcV, ectopic varices; PV, portal vein; TIPS, transjugular intrahepatic portosystemic shunt. * A direct operation or local devascularization of the EcV is a useful procedure even if portal vein is not patent or the patients have Child-Pugh B or C cirrhosis. ** Use TIPS with caution in patients with Child-Pugh C cirrhosis and weigh the benefit of stopping bleeding against the risk of encephalopathy and deterioration in liver function
See this image and copyright information in PMC

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