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Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension

Authors

  • Norihito Watanabe,

    Corresponding author
    1. Department of Internal Medicine, Tokai University School of Medicine, Isehara
    2. Clinical Research Committee of the Japan Society for Portal Hypertension
      Professor Norihito Watanabe, Department of Gastroenterology, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Tokyo 192-0032, Japan. Email: norihito@is.icc.u-tokai.ac.jp
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  • Atsushi Toyonaga,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Division of Gastroenterology, Yasumoto Hospital, Kurume
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  • Seiichiro Kojima,

    1. Department of Internal Medicine, Tokai University School of Medicine, Isehara
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  • Shinji Takashimizu,

    1. Department of Internal Medicine, Tokai University School of Medicine, Isehara
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  • Kazuhiko Oho,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Division of Internal Medicine, Yanagawa Hospital, Yanagawa
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  • Shigehiro Kokubu,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Department of Gastroenterology, Nerima Hospital, Juntendo University School of Medicine, Tokyo
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  • Kenji Nakamura,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Department of Radiology, Osaka City University School of Medicine, Osaka
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  • Akitake Hasumi,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Department of Surgery, Fujita Health University, Toyoake
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  • Naoya Murashima,

    1. Clinical Research Committee of the Japan Society for Portal Hypertension
    2. Division of Gastroenterology, Mishuku Hospital, Tokyo
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  • Takashi Tajiri

    1. Department of Surgery, Nippon Medical School, Tokyo
    2. Chairperson of the Japan Society for Portal Hypertension, Japan
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Professor Norihito Watanabe, Department of Gastroenterology, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Tokyo 192-0032, Japan. Email: norihito@is.icc.u-tokai.ac.jp

Abstract

Aim:  The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan.

Methods:  A total of 173 cases of ectopic varices were collected.

Results:  Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion.

Conslusions:  Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future.

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