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Bleeding ectopic varices: clinical presentation, natural history, and outcomes
  1. Kent A Broussard1,
  2. Don C Rockey2
  1. 1 Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Don C Rockey, Medical University of South Carolina, Charleston, SC 29425, USA; rockey{at}musc.edu

Abstract

Bleeding complications from ectopic varices are often difficult to manage. We aimed to study the natural history and outcomes of bleeding ectopic varices to better understand appropriate clinical management. This retrospective cohort study included patients admitted to the hospital with bleeding ectopic or esophageal varices from 2010 through 2019. Study subjects were identified through searching the Medical University of South Carolina’s electronic medical record, and complete demographic, clinical, and procedural data were abstracted. 25 patients with gastrointestinal bleeding from ectopic varices and a matched group of 50 patients with bleeding esophageal varices were identified. Bleeding ectopic varices were identified in the following locations: duodenum (n=5), jejunum/ileum (n=5), colon (n=2), rectum (n=6), and anastomotic sites (n=7). Model for End-Stage Liver Disease scores (patients with cirrhosis), need for intensive care unit admission, and administration of octreotide and antibiotics were significantly higher in patients with esophageal variceal bleeding than those with ectopic varices. All-cause 1-year mortality of patients with ectopic varices was significantly lower than those with bleeding esophageal varices (8% vs 35%, p<0.05). Patients with ectopic varices and cirrhosis bled at lower hepatic venous pressure gradients than patients with bleeding esophageal varices (17 mm Hg vs 24 mm Hg, p<0.01). Transjugular intrahepatic portosystemic shunts (TIPS) were performed in two-thirds of patients with ectopic varices and one patient rebled due to TIPS dysfunction. The clinical features of patients with ectopic varices and those with esophageal varices were similar, but patients with ectopic varices had significantly lower 1-year mortality after bleeding events.

  • endoscopy
  • liver cirrhosis
  • liver
  • hypertension
  • portal

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors KAB: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. DCR: study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, supervisory activities.

  • Funding This project was supported, in part, by the National Institutes of Health – the National Institute of Diabetes and Digestive and Kidney Disease (grant number P30 DK123704), the National Institute of General Medical Sciences (grant number P20 GM 130457), and the National Center for Advancing Translational Sciences of the (grant number UL1 TR001450).

  • Competing interests DCR is an Associate Editor for the Journal of Investigative Medicine. No other competing interests declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.