Clinical features of 10 cases of cholangiojejunal anastomotic varices

Abstract

Among the ectopic varices, cholangojejunal anastomotic varices are rare, and treatment and long-term prognosis are not clear. Therefore, in order to clarify the clinical characteristics of cholangiojejunal anastomotic varices, we retrospectively examined 10 cases experienced so far. Ten cases were retrospectively evaluated from the three factors: patient factors, treatment factors, and prognostic factors, and their clinical characteristics were identified. There were 8 cases of extrahepatic portal vein obstruction after pancreaticoduodenectomy, and 2 cases of extrahepatic hepaticojejunostomy (Roux-en-Y reconstruction) for biliary atresia. The initial treatment was endoscopic cyanoacrylate injection in 4 cases, para-endoscopic injection sclerotherapy using polidocanol in 2 cases, hemostatic forceps in 1 case, and PSE in 1 case. Two cases were followed up without treatment. In the case of endoscopic cyanoacrylate injection, one case had gastrointestinal perforation, but all were hemostasis with the first treatment and there was no recurrence. On the other hand, all 3 cases of local treatment such as para-endoscopic injection sclerotherapy using polidocanol and hemostatic forceps had recurrence of bleeding, and anastomotic stenosis, liver dysfunction, cholangitis, and liver abscess were observed in 2 cases. In conclusion, from the viewpoint of treatment, endoscopic cyanoacrylate injection may be optimal.