Therapeutic Algorithm for Duodenal Varices: A Case Series

Takashi Matsuda*, Tsuyoshi Ishikawa, Ryo Sasaki, Tatsuro Nishimura, Takuya Iwamoto, Taro Takami, and Isao Sakaida

 

*Department of Liver Regenerative Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi 7558505, Japan

Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi 7558505, Japan

 

Corresponding Author: Takashi Matsuda, Department of Liver Regenerative Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi 7558505, Japan. t.mazda@yamaguchi-u.ac.jp

 

Citation: Matsuda T, Ishikawa T, Sasaki R, Nishimura T, Iwamoto T, Takami T, and Sakaida I (2020) Therapeutic Algorithm for Duodenal Varices: A Case Series. World J Gastroenterol Hepatol Endosc. 3(3); 1-7

 

Copyright: ©2020 Matsuda T, et al., This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

 

ABSTRACT

 

Background: Duodenal varices cause fatal bleeding and are potentially life-threatening. Treatment guidelines for duodenal varices have not yet been established due to their low incidence. We report a case series of patients with duodenal varices admitted to our hospital between April 2012 and June 2017 and share our therapeutic algorithm for duodenal varices.

Case Report: This is a retrospective case series of six patients with duodenal varices. Three of the cases were emergent, two were elective, and one was prophylactic. Therapeutic options for duodenal varices can be classified into endoscopic and endovascular therapies. Using our algorithm, endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate, endoscopic band ligation, or balloon-occluded retrograde transvenous obliteration or both, were performed to eradicate the duodenal varices. In two of the emergent cases, rebleeding occurred after successful primary hemostasis by endoscopic band ligation. In these patients, secondary hemostasis was achieve dwith a combination of endoscopic and endovascular therapies. No recurrences of duodenal varices were reported in any patient.

Conclusion: Duodenal variceal hemorrhage is fatal, and therefore, needs to be treated with an effective therapy as soon as possible. The appropriate treatment method should be chosen on a case-by-case basis considering the hemodynamics and patients’ condition.

 

KEYWORDS: Duodenal varices, Ectopic varices, Endoscopic injection sclerotherapy, Endoscopic band ligation, Balloon-occluded retrograde transvenous obliteration.

 

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