| Autor: |
Chen A; Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China., Li Q; Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China., Zhao L; Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China., Zhang C; Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China., Wang G; Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China. |
| Jazyk: |
angličtina |
| Zdroj: |
Gastrointestinal endoscopy [Gastrointest Endosc] 2024 Jan; Vol. 99 (1), pp. 121-122. Date of Electronic Publication: 2023 Jul 07. |
| DOI: |
10.1016/j.gie.2023.07.005 |
| Abstrakt: |
Competing Interests: Disclosure All authors disclosed no financial relationships. Commentary Gastric varices are most often seen as sequelae of portal hypertension or splenic vein thrombosis. However, other more rare causes should also be considered, as illustrated in these 2 cases. In 1 case, a patient without evidence of cirrhosis presented with hematemesis and hemorrhagic shock and was found to have large gastric varices on endoscopy. Abdominal CT showed a wandering spleen located in the pelvis, with torsion of the splenic vein causing portal hypertension and varices. Hemostasis was achieved with cyanoacrylate injection and band ligation, and ultimately the patient underwent splenectomy, with near resolution of gastric varices at the 18-month follow-up visit. In the other case, gastric varices were noted on upper endoscopy for reflux, and follow-up imaging revealed the spleen to be in 2 parts secondary to childhood trauma, with upper and lower poles separated by a division of the splenic parenchyma. In that case, the gastric collaterals were the dominant arterial supply to the upper spleen, and endoscopic or endovascular embolization would have had a high likelihood of splenic infarction. Given lack of symptoms, a conservative monitoring approach was chosen. It is important to complete a full workup when isolated gastric varices are noted, especially in the absence of liver cirrhosis or splenic vein thrombosis, and to individualize treatment of the condition on the basis of its cause. Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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