Background and Aims
Small-bowel varices (SBVs) are an uncommon consequence of portal hypertension. Radiologic
intervention is usually considered for first-line management. When radiologic intervention
is not possible, management options become very limited. The aim of this study was
to evaluate the usefulness of double-balloon enteroscopy (DBE)-facilitated cyanoacrylate-injection
endotherapy of SBVs.
Methods
This was a retrospective review of DBE-facilitated cyanoacrylate-injection endotherapy
of SBVs (December 2015 to October 2016).
Results
Ten DBEs were performed in 6 patients (4 women; median age, 68.5 years). No radiologic
or surgical options were deemed feasible. Thirteen nests of SBVs were identified and
injected with cyanoacrylate glue without hemorrhagic or embolic adverse events. At
the 30-day follow-up after therapy, only 1 patient had experienced a mild recurrence
of mid-gut bleeding; this was managed conservatively. One patient presented with acute
GI bleeding 7 months later, and a repeat DBE with cyanoacrylate-injection endotherapy
was successfully performed. One patient succumbed to his underlying advanced cholangiocarcinoma
after 2 months. The remaining patients had a median follow-up of 12 months without
any recurrent GI bleeding.
Conclusions
DBE-facilitated cyanoacrylate-injection endotherapy of SBVs appears to be a safe and
effective option when other first-line options are not feasible.
Abbreviations:
DBE (double-balloon enteroscopy), SBVs (small-bowel varices)To read this article in full you will need to make a payment
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References
- Management of ectopic varices.Hepatology. 1998; 28: 1154-1158
- Effects of transjugular intrahepatic portosystemic shunt on changes in the small bowel mucosa of cirrhotic patients with portal hypertension.J Gastroenterol. 2013; 48: 633-639
- The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis.Eur J Gastroenterol Hepatol. 2018; 30: 1187-1193
- Transhepatic portal venous angioplasty with stenting for bleeding jejunal varices.Hepatogastroenterology. 2005; 52: 749-752
- Total enteroscopy with a nonsurgical steerable double-balloon method.Gastrointest Endosc. 2001; 53: 216-220
- Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy.Gastrointest Endosc. 2014; 80: 112-117
- Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions.Am J Gastroenterol. 2012; 107: 240-246
- Successful treatment of bleeding ileal varices by double-balloon enteroscopy and cyanoacrylate injection (with video).Gastrointest Endosc. 2014; 80 (discussion 171): 170-171
- Endoscopic N-butyl-2-cyanoacrylate (Histoacryl) obliteration of jejunal varices by using the double balloon enteroscope.Gastrointest Endosc. 2007; 65: 350-352
- Successful treatment of anastomotic jejunal varices with N-butyl-2-cyanoacrylate (Histoacryl): single-center experience.Endoscopy. 2012; 44: 776-779
- Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review.Endoscopy. 2018; 50: 423-446
- Complete eradication of duodenal varices after endoscopic injection sclerotherapy with ethanolamine oleate: a case report.Gastrointest Endosc. 2008; 67: 759-762
- Duodenal variceal bleeding successfully treated with endoscopic banding (with video).Gastrointest Endosc. 2011; 74: 716-717
- Is it safe to perform endoscopic band ligation for the duodenum? A pilot study in ex vivo porcine models.Minim Invasive Ther Allied Technol. 2013; 22: 80-83
- Current status of ectopic varices in Japan: results of a survey by the Japan Society for Portal Hypertension.Hepatol Res. 2010; 40: 763-776
Article info
Publication history
Published online: April 10, 2019
Accepted:
March 28,
2019
Received:
January 21,
2019
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: E. J. Despott: Research support recipient from Aquilant Medical and Fujifilm; education research recipient from Olympus and Pentax Medical. A. May: Research support recipient from Fujifilm, Olympus, and Interscope. Y. Hayashi: Honoraria from Fujifilm. A. Murino: Research support recipient from Olympus, Pentax, and Fujifilm. All other authors disclosed no financial relationships relevant to this publication.
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© 2019 by the American Society for Gastrointestinal Endoscopy
