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[in Japanese]

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[in Japanese]

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[in Japanese]

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We investigated clinical characteristics of patients with ectopic varices. Evaluated were 11 patients in whom endoscopy confirmed duodenal varices (9 patients) and jejunal varices (2 patients). Patient's data were retrospectively analyzed regarding underling diseases, endoscopic appearance, endoscopic treatment, and prognosis. Underling diseases were liver cirrhosis (LC) in 9 patients and postoperative recurrence of common bile duct cancer (CBDC) in 2 patients. Eight patients with LC showed duodenal varices and one remaining patient showed jejunal varices, and 2CBDC patients showed jejunal varices. Number of patients according to positive/negative red color signs and F₁/F₂/F₃ form classification by EGD were 2/7 and 5/3/1, respectively.
After hemodynamic evaluation by MD-CT and EUS, 2 patients received endoscopic injection sclerotherapy (EIS) using cyanoacrylate and ethanolamine oleate because of bleeding and 1 patient received EIS due to the growth of duodenal varices. Two treatments were elective, and remaining one was prophylactic. Complete eradication of varices was obtained by single sesssion of EIS in two of the 3 patients. The remaining one had recurrent bleeding several times, and needed four additional sessions of EIS for the complete eradication. There were neither severe complications, nor death related to variceal bleeding in a follow-up period. In two patients with jejunal varices, double balloon endoscopy detected varices, while previous EGD failed to detect the ones.

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The hemodynamics and treatment strategy of rectal varices were evaluated 19 cases that were treated in our hospital. The rectal varices were mainly supplied by the dilated inferior mesenteric vein (IMV). On the superior mesenteric arteriography and/or splenic arteriography, the backflow phenomenon of dilated IMV could be observed, and on the abdominal computer tomography (CT), the dilation of caliber of the IMV could be observed. 18 cases were treated with endoscopic therapy (sclerotherapy and/or band ligation) and one case with IMV-IVC shunt ligation. Although one case died rupture from the recurrent rectal varices and six cases required additional treatment, the other12 cases passed without additional treatment (mean followup period 30.6 months). In conclusion, 1) endoscopic therapy for the rectal varices was effective, convenient and safe, and it could be a standard treatment for the rectal varices excluding atypical cases, 2) CT with contrast medium was very useful to evaluate the hemodynamics and curative effects of the rectal varices.

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In order to investigate colorectal complications in portal hypertension, we performed colonoscopy in total of 101 consecutive patients with portal hypertension between June 1, 1999 and June 30, 2003. Portal hypertensive colopathy was defined endoscopically with the presence of vascular ectasias or colorectal varices. The cause of portal hypertension was liver cirrhosis related to hepatitis B (16%) or C (69%) infection, alcoholic liver cirrhosis (6%) and non-cirrhotic portal hypertension (10%). Portal hypertensive colopathy was present in 40 patients (39.6%), in the forms of vascular ectasias in 26 patients (25.7%), ascending colonic varices in 1 patient (1%), and rectal varices in 23 patients (22.7%). Hemorrhage occurred in 5 of the with rectal varices in 1 of the patients with vascular ectasias, and in one with colonic varices. The patients with hemorrhage from rectal varices was treated with elective endoscopic variceal ligation, and the patients with hemorrhage from vascular ectasias was treated with elective argon plasma coagulation. Colorectal varices occurred more frequently in the patients who had received esophageal EVL than in those who hadn't. (14/28 versus 11/73; p < 0.001). However, the presence of colonic vascular ectasias was not related to whether receiving esophageal EVL or not (7/28 versus 18/73; ns).

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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