Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
Internal Medicine, Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
Am J Gastroenterol. 2021 Jul 1;116(7):1426-1436. doi: 10.14309/ajg.0000000000001204.
Esophageal varices are a well-characterized sequela of portal hypertension; however, less is known about varices arising in ectopic locations. We aimed to describe bleeding small intestine varices (SIV) in patients with cirrhosis and compare characteristics and outcomes to published case reports.
We performed an institutional chart review using billing codes and natural language processing between 2008 and 2019. Inclusion criteria were adult patients with cirrhosis and SIV verified by endoscopy, video capsule, or imaging. Patients with noncirrhotic portal hypertension and stomal varices were excluded. We examined demographic and clinical factors, characteristics of SIV, bleeding, intervention, and outcomes in our series and collated data from published cases identified during a literature review.
We identified 71 patients with cirrhosis and SIV (18 bled). The literature search yielded 76 cases with bleeding SIV. Our series and published cases were matched for age, sex, liver disease etiology, and SIV location. Length of stay and transfusion requirements were similar. Aggregate initial treatments (number, hemostasis rate) included medical (n = 7, 57%), endoscopic (n = 48, 56%), interventional radiology (n = 31, 77%), and surgery (n = 8, 87%). Hospital and overall mortality rates were higher in our series (22% and 38%) compared with the published cases (5.3% and 18.4%), respectively (P = 0.02 and P = 0.07).
A quarter of patients with cirrhosis and SIV experience bleeding, with high transfusion requirements, frequent need for secondary interventions, and high mortality. These findings highlight the need for a multidisciplinary approach and second-line therapeutic modalities in the timely management of bleeding SIV in cirrhosis.
食管静脉曲张是门静脉高压的一种特征性后遗症；然而，对于异位起源的静脉曲张，人们知之甚少。我们旨在描述肝硬化患者的小肠静脉曲张（SIV）出血，并将其特征和结局与已发表的病例报告进行比较。
我们使用计费代码和自然语言处理在 2008 年至 2019 年期间进行了机构图表回顾。纳入标准为经内镜、视频胶囊或影像学检查证实的肝硬化和 SIV 的成年患者。排除非肝硬化门静脉高压和门脉侧支静脉曲张的患者。我们检查了我们系列中的人口统计学和临床因素、SIV 的特征、出血、干预和结局，并在文献综述中收集了已发表病例的数据。
我们确定了 71 例肝硬化和 SIV 患者（18 例出血）。文献检索得到 76 例有出血性 SIV 的病例。我们的系列和已发表的病例在年龄、性别、肝病病因和 SIV 位置方面相匹配。住院时间和输血需求相似。初始综合治疗（数量、止血率）包括内科（n = 7，57%）、内镜（n = 48，56%）、介入放射学（n = 31，77%）和手术（n = 8，87%）。与已发表的病例相比，我们的系列中患者的住院和总死亡率更高（分别为 22%和 38%）（P = 0.02 和 P = 0.07）。
四分之一的肝硬化和 SIV 患者会发生出血，需要大量输血，需要频繁进行二级干预，死亡率较高。这些发现强调了在肝硬化患者中及时管理出血性 SIV 需要多学科方法和二线治疗方式。
