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Hemodynamics and Treatment of Ectopic Varices

  • Katsutoshi ObaraEmail author
Chapter

Abstract

Formerly, the presence of ectopic varices was difficult to discover, and mortality rates tended to be high when they began to bleed. Nowadays, advances in diagnostic modalities have enabled ectopic varices to be discovered more frequently. However, few randomized controlled trials of large case series have been conducted on ectopic varices, and no evidence-based guidelines have been published concerning their management. According to a nationwide questionnaire survey carried out in 1990 in Japan, ectopic varices were observed in 129 (0.7%) out of a total of 18,540 patients with a history of receiving endoscopic injection sclerotherapy for esophageal varices, representing a low prevalence; however, the prevalence increased substantially to 3.8% in our data reviewed in 2013. On the other hand, the percentages of bleeding cases were 57.4% in 1990 and 45.1% in 2010, which were not significantly different. In Japan, the majority of ectopic varices develop following endoscopic treatment of esophagogastric varices, and therefore, practitioners should conduct follow-up examinations taking ectopic varices into consideration so that even bleeding ectopic varices can be treated timely and effectively. Modalities often used to detect ectopic varices in Japan include endoscopy, computed tomography, and (color Doppler) endoscopic ultrasonography, while therapeutic options range from endoscopic treatment to surgical operation as well as interventional radiology and pharmacology.

Keywords

Ectopic varices Portal hypertension Endoscopic injection sclerotherapy Endoscopic variceal ligation Interventional radiology 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Advanced Gastrointestinal EndoscopyFukushima Medical UniversityFukushimaJapan

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