1
|
Ghadimi DJ, Ghorani H, Moradi Z, Golezar MH, Nouri S, Irilouzadian R, Zare Dehnavi A, Ebrahimi P, Ghasemi Rad M. Management of ectopic variceal bleeding with transjugular intrahepatic portosystemic shunt: a systematic review of case reports. Emerg Radiol 2024; 31:581-594. [PMID: 38935315 DOI: 10.1007/s10140-024-02258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Ectopic varices account for 5% of variceal bleedings and occur outside the gastro-esophageal region. This review evaluates the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for ectopic variceal management. A comprehensive search through PubMed, Scopus, Web of Science, and Embase was conducted until January 16, 2023, using relevant keywords. Case reports and case series with fewer than 10 patients on TIPS for ectopic variceal management were included. The quality assessment followed the Joanna Briggs Institute checklist for case reports. This systematic review evaluated 43 studies involving 50 patients with ectopic varices undergoing TIPS. Patients had a mean age of 54.3 years, half were female, and two were pregnant. Alcoholic liver disease (48%) and hepatitis C infection (26%) were common causes of portal hypertension. Ascites and splenomegaly were reported in 32% and 28% of the patients, respectively. Rectal, oral, and stomal variceal bleeding accounted for 62%, 16%, and 22% of the patients, respectively. Ectopic varices were mainly located in the duodenum (28%) and rectum (26%) regions. Complications affected 42% of the patients, re-bleeding in eleven and hepatic encephalopathy in seven. The follow-up lasted 12 months on average, and finally, 5 received a liver transplant. Mortality post-TIPS was 18%. Despite complications and a notable mortality rate, favorable outcomes were observed in almost half of the patients with ectopic variceal bleeding managed with TIPS. Further research is warranted to refine strategies and improve patient outcomes.
Collapse
Affiliation(s)
- Delaram J Ghadimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Zahra Moradi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Golezar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
- Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Shadi Nouri
- Department of Radiology, School of Medicine Arak, University of Medical Sciences, Arak, Iran
| | - Rana Irilouzadian
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zare Dehnavi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghasemi Rad
- Department of Interventional Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| |
Collapse
|
2
|
Sotiropoulos C, Sakka E, Diamantopoulou G, Theocharis GJ, Thomopoulos KC. Combination of Percutaneous Transhepatic Balloon-Assisted Transjugular Intrahepatic Collateral Caval Shunt and Embolization for Successful Hemostasis of Lower Gastrointestinal Bleeding Associated With Extremely Enlarged Anorectal Varicose Veins. Cureus 2022; 14:e21053. [PMID: 35165535 PMCID: PMC8828263 DOI: 10.7759/cureus.21053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Ectopic varices may frequently occur in the rectum in the context of portal hypertension. Although rectal variceal bleeding is not a frequent bleeding situation, it can be life-threatening unless diagnosed and treated immediately. However, there is no specific treatment strategy established so far. We report a case of a man with extrahepatic portal hypertension and severe hematochezia due to rectal variceal bleeding. The patient was diagnosed in the past with portal vein thrombosis, in the context of myelodysplastic syndrome/myeloproliferative neoplasm overlap syndrome, with ectopic varices in the small intestine, colon, rectum and anal canal, peritoneum and perisplenic veins, treated with mesorenal shunt placement and an oral beta-blocker. After the initial stabilization with fluid replacement and red blood cell transfusion, he underwent endoscopic injection sclerotherapy, with no effect on bleeding episodes, while the large size of the varices precluded the option of endoscopic band ligation. Due to the presence of large collateral veins next to the inferior vena cava, the patient underwent combination therapy with Percutaneous Transhepatic Balloon-Assisted Transjugular Intrahepatic Collateral Caval shunt placement, to decompress portal pressure, followed by angiographic embolization of the feeding vessels resulting in successful hemostasis. Hematochezia ceased, hemoglobin was stabilized and the patient was safely discharged from the hospital. Controlling and treating rectal varices can be a challenging task indicating the need of a multidisciplinary approach. In the absence of well-established treatment guidelines for rectal varices, we highly recommend treatment of refractory ectopic variceal bleeding, non-responsive to endoscopic treatments, with portocaval shunt placement in combination with embolization.
Collapse
|
3
|
Alhammami QS, Alanazi MHF, Bedaiwi SKA, Alruwili GAN, Alanazi SFK. The Role of Interventional Radiology in Esophageal Varices and Hematemesis: Review Article. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/ujbaqhhovr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
Ma HW, Zhang JH, Ding XP, Yu GW, Ma WJ, Yang J, Ma WL. Endoscopic treatment of esophagogastric variceal bleeding with rectal variceal bleeding: Report of two cases. Shijie Huaren Xiaohua Zazhi 2020; 28:1102-1106. [DOI: 10.11569/wcjd.v28.i21.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophagogastric variceal bleeding is one of the most common and serious complications of portal hypertension in patients with decompensated cirrhosis. However, esophagogastric variceal bleeding with rectal variceal bleeding is clinically rare. If not treated timely or properly, it will cause fatal consequences.
CASE SUMMARY This paper reports two cases of esophagogastric variceal bleeding complicated with rectal varices bleeding. The bleeding was stopped successfully using endoscopic sclerotherapy and ligation method on the basis of drug treatment.
CONCLUSION Clinicians should broaden their thinking and consider the occurrence of such a situation during the treatment of gastrointestinal bleeding.
Collapse
Affiliation(s)
- Hai-Wen Ma
- Medical Department of Northwest Minzu University, Lanzhou 730030, Gansu Province, China
| | - Jin-Hua Zhang
- Department of Gastroenterology, Affiliated Hospital of Northwest Minzu University and the second people's Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China
| | - Xiang-Ping Ding
- Department of Gastroenterology, Affiliated Hospital of Northwest Minzu University and the second people's Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China
| | - Guo-Wei Yu
- Medical Department of Northwest Minzu University, Lanzhou 730030, Gansu Province, China
| | - Wan-Jun Ma
- Medical Department of Northwest Minzu University, Lanzhou 730030, Gansu Province, China
| | - Jie Yang
- Medical Department of Northwest Minzu University, Lanzhou 730030, Gansu Province, China
| | - Wei-Lin Ma
- Medical Department of Northwest Minzu University, Lanzhou 730030, Gansu Province, China
| |
Collapse
|
5
|
Garrido M, Gonçalves B, Ferreira S, Rocha M, Salgado M, Pedroto I. Treating Untreatable Rectal Varices. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:420-424. [PMID: 31832497 DOI: 10.1159/000496121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
Abstract
Background Rectal varices are portosystemic collaterals that arise as a complication of portal hypertension. Despite their significant prevalence among cirrhotic patients, clinically important bleeding occurs only in a minority. Various treatment options are available, with endoscopic therapies being widely used, and both interventional radiology and surgery being considered for refractory bleeding rectal varices. Case We report the case of a 61-year-old male with hepatic cirrhosis and bleedingrectal varices refractory to endoscopic therapy, successfully managed with a combination of transjugular intrahepatic portosystemic shunt (TIPS) and selective variceal embolization. Conclusions Radiological techniques are effective options for refractory bleeding. Adding embolization to TIPS implantation could represent a valid adjunctive measure for haemostasis of recurrent rectal variceal bleeding.
Collapse
Affiliation(s)
- Mónica Garrido
- Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal
| | - Belarmino Gonçalves
- Department of Interventional Radiology, Portuguese Oncology Institute, Porto, Portugal
| | - Sofia Ferreira
- Liver Transplant Unit, Porto University Hospital Centre, Porto, Portugal
| | - Marta Rocha
- Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal.,Institute of Biomedical Sciences of Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Isabel Pedroto
- Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal.,Institute of Biomedical Sciences of Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| |
Collapse
|