Study of endoscopic aspects and therapeutic options of ectopic gastrointestinal varices

ABSTRACT

Ectopic varices are best defined as large porto-systemic venous collaterals occurring anywhere in the abdomen except in the cardio-esophageal region. The aim of this work was to study the pattern of presentation and options of management of eighteen cases with ectopic varices in portal hypertensive patients. Eighteen patients with portal hypertension secondary to liver cirrhosis of different etiologies and ectopic gastrointestinal varices were studied. Gastrointestinal endoscopy was done for all patients and the exact location of ectopic varices was reported. Bleeding ectopic varices were managed endoscopically either by injection sclerotherapy or endoloop ligation according to the situation. Surgical treatment was tried only after failure of endoscopic management. Ten patients presented with gastrointestinal bleeding, while in the other eight patients varices were asymptomatic. Ectopic varices were located in the gastric antrum in two patients, in the duodenal bulb in three, in the descending duodenum in four, in the anorectal region in seven, and at the site of a percutaneous enterostomy [stomal varices] in two patients. Non-bleeding ectopic varices were managed conservatively. Management of bleeding ectopic varices included endoscopic injection sclerotherapy in four, endoscopic endoloop ligation in two, and surgical ligation of the bleeding varix after failure of endoscopic treatment in two patients. Local injection of a natural tissue adhesive was successful to control bleeding in the two patients with stomal variceal bleeding. An excellent outcome was observed in all patients without any reported morbidity or mortality. Bleeding did not recur in any of the patients studied during a follow up period of one year. Ectopic varices should be expected in patients with portal hypertension especially at the sites of previous surgery. Treatment is applied to bleeding varices, while non-bleeding ectopic varices would conservatively be followed-up