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Tranah TH, Nayagam JS, Gregory S, Hughes S, Patch D, Tripathi D, Shawcross DL, Joshi D. Diagnosis and management of ectopic varices in portal hypertension. Lancet Gastroenterol Hepatol 2023; 8:1046-1056. [PMID: 37683687 DOI: 10.1016/s2468-1253(23)00209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 09/10/2023]
Abstract
Ectopic variceal bleeding is a rare cause of gastrointestinal bleeding that can occur in settings of cirrhotic and non-cirrhotic portal hypertension and is characterised by its development at locations remote from the oesophagus and stomach. Ectopic varices can be difficult to identify and access, and, although a relatively uncommon cause of portal hypertensive bleeding, can represent a difficult diagnostic and therapeutic challenge associated with considerable mortality. Low incidence and variance in variceal anatomy preclude large randomised controlled trials, and clinical practice is based on experience from case reports, case series, and specialist centre expertise. Optimisation of survival outcomes relies on understanding a patient's portal venous anatomy and functional hepatic reserve to guide timely and targeted endoscopic and endovascular interventions to facilitate the rapid control of ectopic variceal bleeding.
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Affiliation(s)
- Thomas H Tranah
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK.
| | - Jeremy S Nayagam
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK
| | - Stephen Gregory
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Sarah Hughes
- Department of Gastroenterology and Hepatology, St George's Healthcare NHS Trust, London, UK
| | - David Patch
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and University College London, London, UK
| | - Dhiraj Tripathi
- Department of Liver and Hepato-Pancreato-Biliary Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Debbie L Shawcross
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
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Nasr S, Dahmani W, Jaziri H, Becheikh Y, Ameur W, Elleuch N, Jmaa A. Massive hematochezia due to jejunal varices successfully treated with coil embolization. Clin Case Rep 2022; 10:e6339. [PMID: 36188043 PMCID: PMC9487444 DOI: 10.1002/ccr3.6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/27/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sahar Nasr
- Department of Gastroenterology University of Sousse Sousse Tunisia
| | - Wafa Dahmani
- Department of Gastroenterology University of Sousse Sousse Tunisia
| | - Hanene Jaziri
- Department of Gastroenterology University of Sousse Sousse Tunisia
| | | | - Wafa Ben Ameur
- Department of Gastroenterology University of Sousse Sousse Tunisia
| | - Nour Elleuch
- Department of Gastroenterology University of Sousse Sousse Tunisia
| | - Ali Jmaa
- Department of Gastroenterology University of Sousse Sousse Tunisia
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Furuichi Y, Honjo M, Itoi T. Treatment of jejunal variceal bleeding with portal vein thrombosis after bile duct cancer surgery by short single-balloon endoscope. Dig Endosc 2021; 33:e60-e62. [PMID: 33660344 DOI: 10.1111/den.13938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Yoshihiro Furuichi
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan.,Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Mitsuyoshi Honjo
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan.,Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan
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