Endoscopic management of bleeding ectopic varices: multicentric retrospective case series

Introduction
Portal hypertension is a common complication of liver cirrhosis. Varices are dilated collaterals that develop as a result of portal hypertension at the level of the porto-systemic connections and can cause a shift in the blood flow from high to low pressure. Common locations for porto-systemic shunts are the lower oesophagus and the gastric fundus. Ectopic varices are defined as dilated tortuous veins located at unusual sites other than the gastro-oesophageal junction.

Aim
This research aimed to study the endoscopic assessment of ectopic varices as well as necessary haemostatic interventions to our best knowledge. Also, to perform a review of the literature to compare our results to the most recent available data.

Material and methods
Our group extracted endoscopic reports of patients presenting to the emergency department with evidence of recent GI bleeding in whom ectopic varices were identified. We reported all interventions or procedures needed, details of hospitalization, radiological and laboratory results, as well as follow-up charts.

Results
Our study included 95 patients presenting to the emergency department with evidence of active GI bleeding. Ectopic varices were identified as the source of bleeding in 28 cases. Bleeding from duodenal varices was found in 17 patients and rectal varices in 9 patients. Endoscopic management was used for all cases with active bleeding. Rebleeding from ectopic varices was found in 5 cases, for whom interventional radiology was performed. All cases with rebleeding were duodenal varices. Early mortality occurred in 3 cases after re-intervention.

Conclusions
Our study describes a series of patients with ectopic varices discovered upon emergency endoscopy. Rectal varices were the most commonly found in our series. Bleeding and the need for re-intervention is more common in duodenal varices.