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Endoscopic injection sclerotherapy anastomotic varices in patients with extrahepatic portal obstruction
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Tomohisa Iwai1,
Hisashi Hidaka1,
Chika Kusano1 |
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1Department of Gastroenterology, Kitasato University School of Medicine |
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| Backgrounds and Aims: Ectopic variceal bleeding is often difficult to diagnose and treat properly. Among them, varices of the lifted jejunum that occur after biliary reconstruction are formed when extrahepatic portal obstruction (EHO) causes hepatorenal inflow into the venous plexus at the bile duct jejunal anastomosis. This study aimed to evaluate the results of endoscopic injection sclerotherapy (EIS) for hemorrhagic anastomotic varices by EHO. Subjects and Methods: We retrospectively evaluated 7 cases of anastomotic varices with a history of bleeding between June 2020 and November 2023. When it was difficult to recognize the bleeding point, a forward viewing (FV)-echoendoscope (TGF-UC260J) was inserted into the site to check for blood flow first, then exchange the scope to a colonoscope (PCF-H290). EIS was performed by administering 80% of cyanoacrylate solution using a 21G injection needle. The sclerosing agent was injected from the bleeding site under fluoroscopic guidance to ensure that it did not flow to the liver. Results; All cases underwent pancreaticoduodenectomy and the median time from surgery to treatment was 44.2 months (5.1-170.2). Both procedural and clinical success rates were 100% and a total injection volume of 2.5 ml (1.0-5.0). There was no treatment-related adverse event during the observation period of 4.7 months (2.0-17.3). Conclusions: EIS for anastomotic varices can be performed safely by using 80% cyanoacrylate solution after identifying the responsible vessels by FV-echoendoscope. |
Index Term 1: anastomotic varices
Index Term 2: endoscopic injection therapy
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