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Endoscopy in the management of portal hypertension

  • Conference paper
Portal Hypertension in the 21st Century

Abstract

Endoscopy plays a central role in the management of portal hypertension contributing to: early detection of esophageal and gastric varices (EGV); stratification of patients in terms of their risk of bleeding; primary or secondary prophylactic therapy; monitoring the effect of prophylactic therapies on bleeding risk; and treatment of acute variceal bleeding, portal hypertensive gastropathy (PHG), and ectopic varices. The goal of this chapter is to provide an evidence-based approach to the endoscopic management of portal hypertension.

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References

  1. Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. [Review] [55 refs]. Gastroenterology. 2002;122:1620–30.

    Article  PubMed  Google Scholar 

  2. D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. 1986;31:468–75.

    Article  PubMed  Google Scholar 

  3. El Serag HB, Everhart JE. Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs. Am J Gastroenterol. 2000;95:3566–73.

    Article  PubMed  CAS  Google Scholar 

  4. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80:800–9.

    PubMed  CAS  Google Scholar 

  5. Poynard T, Cales P, Pasta L et al. β-Adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group. N Engl J Med. 1991;324:1532–8.

    Article  PubMed  CAS  Google Scholar 

  6. Grace ND. Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 1997;92:1081–91.

    PubMed  CAS  Google Scholar 

  7. Grace ND, Groszmann RJ, Garcia-Tsao G et al. Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology. 1998;28:868–80.

    Article  PubMed  CAS  Google Scholar 

  8. Spiegel BM, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: Is it ever cost effective? Hepatology. 2003;37:366–77.

    Article  PubMed  Google Scholar 

  9. Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. [Review] [55 refs]. Gastroenterology. 2002;122:1620–30.

    Article  PubMed  Google Scholar 

  10. Giannini E, Botta F, Borro P et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200–5.

    Article  PubMed  CAS  Google Scholar 

  11. Giannini E, Botta F, Borro P et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200–5.

    Article  PubMed  CAS  Google Scholar 

  12. Saeian K, Staff D, Knox J et al. Unsedated trans nasal endoscopy: a new technique for accurately detecting and grading esophageal varices in cirrhotic patients. Am J Gastroenterol. 2002;97:2246–9.

    Article  PubMed  Google Scholar 

  13. Arguedas MR, McGuire BM, Fallon MB, Abrams GA. The use of screening and preventive therapies for gastroesophageal varices in patients referred for evaluation of orthotopic liver transplantation. Am J Gastroenterol. 2001;96:833–7.

    Article  PubMed  CAS  Google Scholar 

  14. Plevris JN, Elliot R, Mills PR et al. Effect of propranolol on prevention of first variceal bleed and survival in patients with chronic liver disease. Aliment Pharmacol Ther. 1994;8:63–70.

    Article  PubMed  CAS  Google Scholar 

  15. Cales P, Oberti F, Payen JL et al. Lack of effect of propranolol in the prevention of large oesophageal varices in patients with cirrhosis: a randomized trial. French-Speaking Club for the Study of Portal Hypertension. Eur J Gastroenterol Hepatol. 1999;11:741–5.

    Article  PubMed  CAS  Google Scholar 

  16. Beppu K, Inokuchi K, Koyanagi N et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc. 1981;27:213–18.

    Article  PubMed  CAS  Google Scholar 

  17. Idezuki Y. General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension. World J Surg. 1995;19:420–2.

    Article  PubMed  CAS  Google Scholar 

  18. Schiano TD, Adrain AL, Vega KJ, Liu JB, Black M, Miller LS. High-resolution endoluminal sonography assessment of the hematocystic spots of esophageal varices. Gastrointest Endosc. 1999;49:424–7.

    Article  PubMed  CAS  Google Scholar 

  19. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices.[see comment]. N Engl I Med. 1988; 319:983–9.

    Google Scholar 

  20. Thuluvath PJ, Krishnan A. Primary prophylaxis of variceal bleeding. [Review] [59 refs]. Gastrointest Endosc. 2003;58:558–67.

    Article  PubMed  Google Scholar 

  21. Rigau J, Bosch J, Bordas JM et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage. Gastroenterology. 1989; 96:873–80.

    PubMed  CAS  Google Scholar 

  22. Gertsch P, Fischer G, Kleber G, Wheatley AM, Geigenberger G, Sauerbruch T. Manometry of esophageal varices: comparison of an endoscopic balloon technique with needle puncture. Gastroenterology. 1993;105:1159–66.

    PubMed  CAS  Google Scholar 

  23. Miller L, Banson FL, Bazir K et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol. 2003;98:454–9.

    Article  PubMed  Google Scholar 

  24. Miller ES, Kim JK, Gandehok J et al. A new device for measuring esophageal variceal pressure. Gastrointest Endosc. 2002;56:284–91.

    Article  PubMed  Google Scholar 

  25. Pontes JM, Leitao MC, Portela F, Nunes A, Freitas D. Endosonographic Doppler-guided manometry of esophageal varices: experimental validation and clinical feasibility. Endoscopy. 2002;34:966–72.

    Article  PubMed  CAS  Google Scholar 

  26. Ichikawa S, Okamura S, Tujigami K et al. Quantitative analysis of red color sign in the endoscopic evaluation of esophageal varices. Endoscopy. 2001;33:747–53.

    Article  PubMed  CAS  Google Scholar 

  27. Hosking SW, Johnson AG. Gastric varices: a proposed classification leading to management. Br J Surg. 1988;75:195–6.

    Article  PubMed  CAS  Google Scholar 

  28. Hashizume M, Kitano S, Yamaga H, Koyanagi N, Sugimachi K. Endoscopic classification of gastric varices. Gastrointest Endosc. 1990;36:276–80.

    Article  PubMed  CAS  Google Scholar 

  29. Sarin SK, Kumar A. Gastric varices: profile, classification, and management. [Review] [72 refs]. Am J Gastroenterol. 1989;84:1244–9.

    PubMed  CAS  Google Scholar 

  30. Sarin SK, Jain AK, Lamba GS, Gupta R, Chowdhary A. Isolated gastric varices: prevalence, clinical relevance and natural history. Dig Surg. 2003;20:42–7.

    Article  PubMed  CAS  Google Scholar 

  31. Thuluvath PJ, Krishnan A. Primary prophylaxis of variceal bleeding. [Review] [59 refs]. Gastrointest Endosc. 2003;58:558–67.

    Article  PubMed  Google Scholar 

  32. Avgerinos A, Armonis A, Manolakopoulos S et al. Endoscopic sclerotherapy plus propranolol versus propranolol alone in the primary prevention of bleeding in high risk cirrhotic patients with esophageal varices: a prospective multicenter randomized trial. Gastrointest Endosc. 2000;51:652–8.

    Article  PubMed  CAS  Google Scholar 

  33. Lo GH, Lai KH, Cheng JS, Lin CK, H su PI, Chiang HT. Prophylactic banding ligation of high-risk esophageal varices in patients with cirrhosis: a prospective, randomized trial. J Hepatol. 1999;31:451–6.

    Article  PubMed  CAS  Google Scholar 

  34. Sarin SK, Guptan RK, Jain AK, Sundaram KR. A randomized controlled trial of endoscopic variceal band ligation for primary prophylaxis of variceal bleeding [see comment]. Eur J Gastroenterol Hepatol. 1996;8:337–42.

    Article  PubMed  CAS  Google Scholar 

  35. Sarin SK, Lamba GS, Kumar M, Misra A, Murthy NS. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleedin [see comment]. N Engl J Med. 1999;340:988–93.

    Article  PubMed  CAS  Google Scholar 

  36. Lay CS, Tsai YT, Teg CY et al. Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices [see comment]. Hepatology. 1997;25:1346–50.

    Article  PubMed  CAS  Google Scholar 

  37. Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J. A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices. Surg Endosc. 1999;13:580–4.

    Article  PubMed  CAS  Google Scholar 

  38. Burroughs AK, Patch D. Primary prevention of bleeding from esophageal varices [comment]. N Engl J Med. 1999;340:1033–5.

    Article  PubMed  CAS  Google Scholar 

  39. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding [see comment]. Hepatology. 2001;33:802–7.

    Article  PubMed  CAS  Google Scholar 

  40. Sarin SK, Lamba GS, Kumar M, Misra A, Murthy NS. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding [see comment]. N Engl J Med. 1999;340:988–93.

    Article  PubMed  CAS  Google Scholar 

  41. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding [see comment]. Hepatology. 2001;33:802–7.

    Article  PubMed  CAS  Google Scholar 

  42. Lui HF, Stanley AJ, Forrest EH et al. Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate [see comment]. Gastroenterology. 2002;123:735–44.

    Article  PubMed  CAS  Google Scholar 

  43. Spiegel BM, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: Is it ever cost effective? Hepatology. 2003;37:366–77.

    Article  PubMed  Google Scholar 

  44. Saab S, DeRosa V, Nieto J, Durazo F, Han S, Roth B. Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: a decision analytic model. Am J Gastroenterol. 2003;98:763–70.

    Article  PubMed  Google Scholar 

  45. Thuluvath PJ, Krishnan A. Primary prophylaxis of variceal bleeding. [Review] [59 refs]. Gastrointest Endosc. 2003;58:558–67.

    Article  PubMed  Google Scholar 

  46. Leung VK, Sung JJ, Ahuja AT et al. Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding. Gastroenterology. 1997; 112:1811–16.

    Article  PubMed  CAS  Google Scholar 

  47. Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointest Endosc. 2002;55:197–203.

    Article  PubMed  Google Scholar 

  48. Ziegler K, Gregor M, Zeitz M, Zimmer T, Habermann F, Riecken EO. Evaluation of endosonography in sclerotherapy of esophageal varices [see comment]. Endoscopy. 1991;23:247–50.

    Article  PubMed  CAS  Google Scholar 

  49. Pontes JM, Leitao MC, Portela FA, Rosa AM, Ministro P, Freitas DS. Endoscopic ultrasonography in the treatment of oesophageal varices by endoscopic sclerotherapy and band ligation: do we need it? Eur J Gastroenterol Hepatol. 1995;7:41–6.

    PubMed  CAS  Google Scholar 

  50. Nagamine N, Ueno N, Tomiyama T et al. A pilot study on modified endoscopic variceal ligation using endoscopic ultrasonography with color Doppler function [see comment]. Am J Gastroenterol. 1998;93:150–5.

    Article  PubMed  CAS  Google Scholar 

  51. Nagamine N, Ido K, Ueno N et al. The usefulness of ultrasonic microprobe imaging for endoscopic variceal ligation. Am J Gastroenterol. 1996;91:523–9.

    PubMed  CAS  Google Scholar 

  52. Iwase H, Suga S, Morise K, Kuroiwa A, Yamaguchi T, Horiuchi Y. Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue. Gastrointest Endosc. 1995;41:150–4.

    Article  PubMed  CAS  Google Scholar 

  53. Lee YT, Chan FK, Ng EK et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices [see comment]. Gastrointest Endosc. 2000;52:168–74.

    Article  PubMed  CAS  Google Scholar 

  54. Burroughs AK. The natural history of varices. [Review] [12 refs]. J Hepatol. 1993;17:Suppl-3.

    Google Scholar 

  55. El Serag HB, Everhart JE. Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs. Am J Gastroenterol. 2000;95:3566–73.

    Article  PubMed  CAS  Google Scholar 

  56. Chalasani N, Kahi C, Francois F et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol. 2003;98:653–9.

    Article  PubMed  Google Scholar 

  57. Burroughs AK, Mezzanotte G, Phillips A, McCormick PA, Mcintyre N. Cirrhotics with variceal hemorrhage: the importance of the time interval between admission and the start of analysis for survival and rebleeding rates. Hepatology. 1989;9:801–7.

    Article  PubMed  CAS  Google Scholar 

  58. Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. [Review] [ 45 refs]. J Hepatol. 2000;32:865–71.

    Article  PubMed  CAS  Google Scholar 

  59. Ludwig J, Hashimoto E, Obata H, Baldus WP. Idiopathic portal hypertension. Hepatology. 1993;17:1157–62.

    Article  PubMed  CAS  Google Scholar 

  60. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80:800–9.

    PubMed  CAS  Google Scholar 

  61. Cardenas A, Gines P, Uriz J et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001;34:671–6.

    Article  PubMed  CAS  Google Scholar 

  62. Castaneda B, Morales J, Lionetti R et al. Effects of blood volume restitution following a portal hypertensive-related bleeding in anesthetized cirrhotic rats. Hepatology. 2001; 33:821–5.

    Article  PubMed  CAS  Google Scholar 

  63. Ejlersen E, Melsen T, Ingerslev J, Andreasen RB, Vilstrup H. Recombinant activated factor VII (rFVIIa) acutely normalizes prothrombin time in patients with cirrhosis during bleeding from oesophageal varices. Scand J Gastroenterol. 2001;36:1081–5.

    Article  PubMed  CAS  Google Scholar 

  64. Romero-Castro R, Jimenez-Saenz M, Pellicer-Bautista F et al. Recombinant-activated factor VII as hemostatic therapy in eight cases of severe hemorrhage from esophageal varices. Clin Gastroenterol Hepatol. 2004;2:78–84.

    Article  PubMed  CAS  Google Scholar 

  65. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655–61.

    Article  PubMed  CAS  Google Scholar 

  66. D’Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. [Review] [71 refs]. Baillieres Clin Gastroenterol. 1997;11:243–56.

    Article  PubMed  Google Scholar 

  67. Kim T, Shijo H, Kokawa H et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–12.

    Article  PubMed  CAS  Google Scholar 

  68. Ramond MJ, Valla D, Gotlib JP, Rueff B, Benhamou JP. [Endoscopic obturation of esophagogastric varices with bucrylate. I. Clinical study of 49 patients]. [French]. Gastroenterol Clin Biol. 1986;10:575–9.

    PubMed  CAS  Google Scholar 

  69. See A, Florent C, Lamy P, Levy VG, Bouvry M. [Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients]. [French]. Gastroenterol Clin Biol. 1986;10:604–7.

    PubMed  CAS  Google Scholar 

  70. Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18:25–6.

    Article  PubMed  CAS  Google Scholar 

  71. See A, Florent C, Lamy P, Levy VG, Bouvry M. [Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients]. [French]. Gastroenterol Clin Biol. 1986;10:604–7.

    PubMed  CAS  Google Scholar 

  72. Gallet B, Zemour G, Saudemont JP, Renard P, Hillion ML, Hiltgen M. Echocardiographic demonstration of intracardiac glue after endoscopic obturation of gastroesophageal varices. J Am Soc Echocardiogr. 1995;8:t–61.

    Google Scholar 

  73. Hwang SS, Kim HH, Park SH et al. N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comp Assist Tomogr. 2001;25:16–22.

    Article  CAS  Google Scholar 

  74. Tsokos M, Bartel A, Schoel R, Rabenhorst G, Schwerk WB. [Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix]. [German]. Deutsche Med Wochenschr. 1998; 123:691–5.

    Article  CAS  Google Scholar 

  75. Palejwala AA, Smart HL, Hughes M. Multiple pulmonary glue emboli following gastric variceal obliteration. Endoscopy. 2000;32:S1–S2.

    Article  PubMed  CAS  Google Scholar 

  76. Kull E, Hernandez M, Richer JP, Borderie C, Silvain C, Beauchant M. [Severe pulmonary embolism after obturation of gastric varices with a butyl-cyanoacrylate and lipiodol combination]. [French]. Gastroenterol Clin BioI. 1999;23:1095–6.

    CAS  Google Scholar 

  77. Tan YM, Goh KL, Kamarulzaman A et al. Multiple systemic embolisms with septicemia after gastric variceal obliteration with cyanoacrylate [see comment]. Gastrointest Endosc. 2002;55:276–8.

    Article  PubMed  Google Scholar 

  78. Roesch W, Rexroth G. Pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy. 1998;30:S89–S90.

    PubMed  CAS  Google Scholar 

  79. Cheng PN, Sheu BS, Chen CY, Chang TT, Lin XZ. Splenic infarction after histoacryl injection for bleeding gastric varices. Gastrointest Endosc. 1998;48:426–7.

    Article  PubMed  CAS  Google Scholar 

  80. Turler A, Wolff M, Dorlars D, Hirner A. Embolic and septic complications after sclerotherapy of fundic varices with cyanoacrylate. Gastrointest Endosc. 2001;53:228–30.

    Article  PubMed  CAS  Google Scholar 

  81. Shim CS, Cho YD, Kim JO et al. A case of portal and splenic vein thrombosis after Histoacryl injection therapy in gastric varices. Endoscopy. 1996;28:461.

    Article  PubMed  CAS  Google Scholar 

  82. Battaglia G, Morbin T, Patarnello E, Merkel C, Corona MC, Ancona E. Visceral fistula as a complication of endoscopic treatment of esophageal and gastric varices using isobutyl-2-cyanoacrylate: report of two cases. Gastrointest Endosc. 2000;52:267–70.

    Article  PubMed  CAS  Google Scholar 

  83. Soehendra N, Grimm H, Nam VC, Berger B. N-butyl-2-cyanoacrylate: a supplement to endoscopic sclerotherapy. Endoscopy. 1987; 19:221–4.

    Article  PubMed  CAS  Google Scholar 

  84. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–15.

    Article  PubMed  CAS  Google Scholar 

  85. Przemioslo RT, McNair A, Williams R. Thrombin is effective in arresting bleeding from gastric variceal hemorrhage. Dig Dis Sci. 1999;44:778–81.

    Article  PubMed  CAS  Google Scholar 

  86. Datta D, Vlavianos P, Alisa A, Westaby D. Use of fibrin glue (beriplast) in the management of bleeding gastric varices. Endoscopy. 2003;35:675–8.

    Article  PubMed  CAS  Google Scholar 

  87. Lee MS, Cho JY, Cheon YK et al. Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices [see comment]. Gastrointest Endosc. 2002;56:83–8.

    Article  PubMed  Google Scholar 

  88. Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc. 1997;46:8–14.

    Article  PubMed  CAS  Google Scholar 

  89. Kanagawa H, Mirna S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde trans venous obliteration. J Gastroenterol Hepatol. 1996;11:51–8.

    Article  PubMed  CAS  Google Scholar 

  90. Shiba M, Higuchi K, Nakamura K et al. A case of huge gastric varices successfully treated with endoscopic injection sclerotherapy with occlusion of both supplying and draining veins with balloons. Gastrointest Endosc. 2000;52:104–7.

    Article  PubMed  CAS  Google Scholar 

  91. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis [see comment]. Ann Intern Med. 1995;123:280–7.

    PubMed  CAS  Google Scholar 

  92. Villanueva C, Minana J, Ortiz J et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding [see comment] [summary for patients in Gastrointest Endosc. 2002 May; 55:761-4; PMID: 12085777]. N Engl J Med. 2001;345:647–55.

    Article  PubMed  CAS  Google Scholar 

  93. Lo GH, Lai KH, Cheng JS et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial [see comment]. Hepatology. 2000;32:461–5.

    Article  PubMed  CAS  Google Scholar 

  94. Hepworth CC, Burnham WR, Swain CP. Development and application of endoloops for the treatment of bleeding esophageal varices. Gastrointest Endosc. 1999;50:677–84.

    Article  PubMed  CAS  Google Scholar 

  95. Shim CS, Cho JY, Park YJ et al. Mini-detachable snare ligation for the treatment of esophageal varices. Gastrointest Endosc. 1999;50:673–6.

    Article  PubMed  CAS  Google Scholar 

  96. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Meucci C, Piscopo R. Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial [see comment]. Gastrointest Endosc. 2002;56:467–71.

    Article  PubMed  Google Scholar 

  97. Chaves DM, Sakai P, Mucenic M, Iriya K, Iriya Y, Ishioka S. Comparative study of portal hypertensive gastropathy in schistosomiasis and hepatic cirrhosis. Endoscopy. 2002;34: 199–202.

    PubMed  Google Scholar 

  98. Hashizume M, Tanoue K, Ohta M et al. Vascular anatomy of duodenal varices: angiographic and histopathological assessments. Am J Gastroenterol. 1993;88:1942–5.

    PubMed  CAS  Google Scholar 

  99. Heaton ND, Khawaja H, Howard ER. Bleeding duodenal varices. Br J Surg. 1991;78:1450–1.

    Article  PubMed  CAS  Google Scholar 

  100. Lebrec D, Benhamou JP. Ectopic varices in portal hypertension. Clin Gastroenterol. 1985;14:105–21.

    PubMed  CAS  Google Scholar 

  101. Heaton ND, Khawaja H, Howard ER. Bleeding duodenal varices. Br J Surg. 1991;78:1450–1.

    Article  PubMed  CAS  Google Scholar 

  102. Tazawa J, Sakai Y, Koizumi K et al. Endoscopic ligation for ruptured duodenal varices. Am J Gastroenterol. 1995;90:677–8.

    PubMed  CAS  Google Scholar 

  103. Fayad N, Nammour F, Elfant A. Endoscopic variceal ligation for bleeding duodenal varices. J Clin Gastroenterol. 2004;38:467.

    Article  PubMed  CAS  Google Scholar 

  104. Shiraishi M, Hiroyasu S, Higa T, Oshiro S, Muto Y. Successful management of ruptured duodenal varices by means of endoscopic variceal ligation: report of a case. Gastrointest Endosc. 1999;49:255–7.

    Article  PubMed  CAS  Google Scholar 

  105. Bosch A, Marsano L, Varilek GW. Successful obliteration of duodenal varices after endoscopic ligation. Dig Dis Sci. 2003;48:1809–12.

    Article  PubMed  Google Scholar 

  106. Bhasin DK, Sharma BC, Sriram PV, Makharia G, Singh K. Endoscopic management of bleeding ectopic varices with histoacryl. HPB Surg. 1999;11:171–3.

    Article  PubMed  CAS  Google Scholar 

  107. Ota K, Shirai Z, Masuzaki T et al. Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices. J Gastroenterol. 1998;33:550–5.

    Article  PubMed  CAS  Google Scholar 

  108. Yoshida Y, Imai Y, Nishikawa M et al. Successful endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate following the recurrence of bleeding soon after endoscopic ligation for ruptured duodenal varices. Am J Gastroenterol. 1997;92:1227–9.

    PubMed  CAS  Google Scholar 

  109. D’Imperio N, Piemontese A, Baroncini D et al. Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy. 1996;28:239–43.

    Article  PubMed  Google Scholar 

  110. Wu CS, Chen CM, Chang KY. Endoscopic injection sclerotherapy of bleeding duodenal varices. J Gastroenterol Hepatol. 1995;10:481–3.

    Article  PubMed  CAS  Google Scholar 

  111. Rai R, Panzer SW, Miskovsky E, Thuluvath PJ. Thrombin injection for bleeding duodenal varices. Am J Gastroenterol. 1994;89:1871–3.

    PubMed  CAS  Google Scholar 

  112. Cottam DR, Clark R, Hayn E, Shaftan G. Duodenal varices: a novel treatment and literature review. Am Surg. 2002;68:407–9.

    PubMed  Google Scholar 

  113. Menu Y, Gayet B, Nahum H. Bleeding duodenal varices: diagnosis and treatment by percutaneous portography and transcatheter embolization. Gastrointest Radiol. 1987; 12:111–13.

    Article  PubMed  CAS  Google Scholar 

  114. Ota K, Okazaki M, Higashihara H et al. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices. J Gastroenterol. 1999;34:694–9.

    Article  PubMed  CAS  Google Scholar 

  115. Haskal ZJ, Scott M, Rubin RA, Cope C. Intestinal varices: treatment with the transjugular intrahepatic porto systemic shunt. Radiology. 1994;191:183–7.

    PubMed  CAS  Google Scholar 

  116. Yamamoto H, Sekine Y, Sato Y et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–20.

    Article  PubMed  CAS  Google Scholar 

  117. Goenka MK, Kochhar R, Nagi B, Mehta SK. Rectosigmoid varices and other mucosal changes in patients with portal hypertension. Am J Gastroenterol. 1991;86:1185–9.

    PubMed  CAS  Google Scholar 

  118. Hamlyn AN, Morris JS, Lunzer MR, Puritz H, Dick R. Portal hypertension with varices in unusual sites. Lancet. 1974;2:1531–4.

    Article  PubMed  CAS  Google Scholar 

  119. Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet. 1989;1:349–52.

    Article  PubMed  CAS  Google Scholar 

  120. Ganguly S, Sarin SK, Bhatia V, Lahoti D. The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension. Hepatology. 1995; 21:1226–31.

    PubMed  CAS  Google Scholar 

  121. Levine J, Tahiri A, Banerjee B. Endoscopic ligation of bleeding rectal varices. Gastrointest Endosc. 1993;39:188–90.

    Article  PubMed  CAS  Google Scholar 

  122. Chen WC, Hou MC, Lin HC, Chang FY, Lee SO. An endoscopic injection with N-butyl-2-cyanoacrylate used for colonic variceal bleeding: a case report and review of the literature. Am J Gastroenterol. 2000;95:540–2.

    Article  PubMed  CAS  Google Scholar 

  123. Schafer TW, Binmoeller KF. Argon plasma coagulation for the treatment of colonic varices. Endoscopy. 2002;34:661–3.

    Article  PubMed  CAS  Google Scholar 

  124. Beppu K, Inokuchi K, Koyanagi N et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc. 1981;27:213–18.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. The Center for Therapeutic Endoscopy and Endoscopic Oncology, St Michaels Hospital, 30 Bond Street, Toronto, Ontario, M5B 1 W8, Canada

    Norman E. Marcon

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  1. Gregory J. Monkewich
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  2. Norman E. Marcon
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Editors and Affiliations

  1. Yale University School of Medicine, New Haven, CT, USA

    R. J. Groszmann

  2. Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic, University of Barcelona, Spain

    J. Bosch

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© 2004 Springer Science+Business Media Dordrecht

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Monkewich, G.J., Marcon, N.E. (2004). Endoscopy in the management of portal hypertension. In: Groszmann, R.J., Bosch, J. (eds) Portal Hypertension in the 21st Century. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1042-9_21

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  • DOI: https://doi.org/10.1007/978-94-007-1042-9_21

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3774-7

  • Online ISBN: 978-94-007-1042-9

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