| ObjectiveEctopic varices(ECV)are a heterogeneous group of venous shunts located anywhere in the mesenteric vascular bed with the exception of gastroesophageal region(GV)that are considered separately.In general,ECV include duodenal varices(DV),small bowel varices(SBV),colonic varices(CV),rectal varices(RV),biliary varices,peritoneal varices,anastomotic varices(SV),etc.Currently,research on EcV is very limited,and treatment of EcV has not yet established an expert consensus or guidelines.With the deepening of clinicians' understanding of EcV,it was found that these patients have the characteristics of difficult diagnosis,massive bleeding,difficulty in hemostasis,and poor prognosis.Studies have shown that DV rebleeding rate and mortality can be as high as 40%,DV is attracting more and more attention.According to the differency of method of examination,of etiology and location of EcV,the prevalence of EcV varies greatly.In this study,We aimed to retrospectively analyze the clinical characteristics and risk factors associated with bleeding and evaluate efficacy of endoscopic treatment of EcV in the First Affiliated Hospital of Nanchang University during the past 10 years.MethodsFrom January 1th,2007 to July 31 th,2017,we collected a total of 165 patients with EcV by endoscopic diagnosis in the endoscopy center of First Affiliated Hospital of Nanchang University,and these patients underwent 203 cases of endoscopic examination and treatment.The clinical data,endoscopic characteristics,endoscopic treatment and follow-up outcome of EcV patients were summarized,and the efficacy of different methods(endoscopic band ligation,endoscopic injection sclerotherapy,endoscopic injection cyanoacrylate and endoscopic sclerotherapy with cyanoacrylate injection)of endoscopic treatment for EcV was statistically analyzed.Results1?General clinical dataBetween January 2007 and July 2017,165 patients with EcV were collected.124 were males and 41 females.The ratio of male to female was 3.02:1,and the age was 16-88(53.80 + 14.41)years.The 89 hospitalized patients and 76 non-inpatient patients.23 patients with EcV had a total of 36 cases of variceal bleeding,of which DV,RV,CV,SV,and SBV were 21,9,3,2,and 1 respectively,and DV accounted for 58.33%.20 cases of EcV were active bleeding and 16 had no active bleeding under endoscopy.27 cases of EcV underwent endoscopic treatment,and other 9 cases did not undergo endoscopic treatment.There were a total of 27 cases of endoscopic treatment.18 cases of DV,of which 13 cases had endoscopic active bleeding and 5 cases had no active bleeding under endoscopy.2?The etiology of EcVThe etiology of 64 patients was PH of liver cirrhosis,2 patients with superior mesenteric venous thrombosis,1 patient with portal cavernous sinusoidosis,3 patients with pancreatic origin PH,1 patient with mesenteric torsion,1 patient with idiopathic RV,93 patients with etiology unclear.The etiology of inpatients was mainly cirrhotic portal hypertension,accounted for 67.42%(60/89).The etiology of liver cirrhosis is mainly hepatitis B,accounted for 57.81%(37/64).94.74%(72/76)non-inpatients have unclear etiology.3?Composition ratio and detection rate of EcV3.1 Composition ratio:165 patients underwent a total of 203 cases of endoscopic examination and treatment,among which RV,DV,CV,SV,and SBV were 141,42,15,and 4,1 case,respectively.EcV accounted for approximately 1.23%(203/16271)of all varices in the gastrointestinal tract during the 10 years.3.2 Detection rate:the 10-year endoscopic detection rate of RV? DV ?CV ?SV?SBV were 98.1/100,000,8.42/100,000,and 10.44/100,000,0.62/100,000,61.9/ 100,000,respectively.10 years overall detection rate of EcV was 3.15/10,000.From 2008 to 2017,the annual endoscopic detection rate of EcV has increased from 17.5/100,000 to 43.0/100,000.The endoscopic detection rate of DV has increased from 3.4 /100,000 to 25.41 /100,000.The detection rate of RV showed no significant increase or decrease.The bleeding rates of DV,RV,and CV were 50%,6.38%,and 20%,respectively.The 10-year detection rate of EcV of upper gastrointestinal endoscopy,colonoscopy,small bowel endoscopy was 8.44/100,000,109.28/100,000,242.22/100,000,respectively.4?Risk factors associated with EcV bleedingThe factors,including age,EcV distribution,size of varices,erythema,collateral,and combining other varices,were included in the Logistic regression analysis at the same time,The results showed that age,EcV distribution,size of varices,and erythema were risk factors associated with EcV bleeding.5?Efficacy of endoscopic treatment of EcV and follow-up outcome5.1 Efficacy of endoscopic treatment of EcV: Immediate hemostasis after endoscopic treatment for EcV was 100%(17/17),initial hemostasis was 92.59%(25/27),and the treatment success rate was 70.37%(19/27).The overall initial hemostasis rate for endoscopic ligation was 90.9%.The overall preliminary hemostasis rate for endoscopic sclerotherapy was 93.75%.There was no statistical difference between the two groups(P>0.05).The overall success rate of endoscopic ligation was 72.73%,and the overall success rate of endoscopic sclerotherapy was 68.75%.There was no statistical difference between the two groups.P>0.05.The immediate hemostasis in DV was 100%(13/13),the initial hemostasis was 88.89%(16/18),and the overall treatment success was 72.22%(13/18).5.2 follow-up outcome after endoscopy treatment: The rebleeding rates at 6 weeks,3 months,6 months,and 1 years were 13.33%,26.67%,33.3% and 46.67%,respectively.The overall mortality rate was 26.67%,and the 6 and 1 year mortality rates were 0% and 13.33%,respectively.The main adverse event was ulcer after endoscopic treatment,the incidence rate was 14.8%,and no embolism was observed.Conclusions1?In patient with gastrointestinal EcV,DV is more prone to bleeding than other types of EcV patients.2?Diameter of varices and erythema is a risk factor for EcV bleeding,age is a protective factor for bleeding.Whether EcV is bleeding,it is related to its distribution.3?Endoscopic treatment of gastrointestinal EcV is feasible,safe,and effective.There was no significant difference in the efficacy of EcV between different endoscopic treatments. |
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