Xiao Nian-Jun, Chu Jian-Guo, Ning Shou-Bin, Wei Bao-Jie, Xia Zhi-Bo, Han Zhe-Yi
Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China.
World J Gastrointest Surg. 2025 Mar 27;17(3):102589. doi: 10.4240/wjgs.v17.i3.102589.
Bleeding ectopic varices located in the small bowel (BEV-SB) caused by portal hypertension (PH) are rare and life-threatening clinical scenarios. The current management of BEV-SB is unsatisfactory. This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy (EIS) and subsequent interventional radiology (IR).
To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.
This was a single tertiary care center before-after study, including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center. A retrospective review of the medical records was conducted. The management of these four patients involved the utilization of EIS followed by IR. The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches: Phase 1, from the initial occurrence of BEV-SB to the initial EIS; phase 2, from the initial EIS to the initial IR treatment; and phase 3, from the initial IR to December 2023. Descriptive statistics were performed to clarify the blood transfusions in each phase.
Four out of 519 patients diagnosed with PH were identified as having BEV-SB. The management duration of each phase was 20 person-months, 42 person-months, and 77 person-months, respectively. The four patients received a total of eight and five person-times of EIS and IR treatment, respectively. All patients exhibited recurrent gastrointestinal bleeding following the first EIS, while no further instances of gastrointestinal bleeding were observed after IR treatment. The transfusions administered during each phase were 34, 31, and 3.5 units of red blood cells, and 13 units, 14 units, and 1 unit of plasma, respectively.
EIS may be effective in achieving hemostasis for BEV-SB, but rebleeding is common, and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.
由门静脉高压（PH）引起的位于小肠的出血性异位静脉曲张（BEV-SB）是罕见且危及生命的临床情况。目前对BEV-SB的治疗并不理想。本回顾性研究分析了4例由PH引起的BEV-SB病例，并详细介绍了使用肠镜下注射硬化疗法（EIS）及随后的介入放射学（IR）对这些病例的治疗情况。
分析由PH引起的BEV-SB的治疗方法并制定治疗方案。
这是一项单中心三级医疗中心的前后对照研究，纳入了2019年1月至2023年12月期间在空军医疗中心被诊断为继发于PH的BEV-SB的4例患者。对病历进行回顾性分析。这4例患者的治疗包括先采用EIS，随后进行IR。基于这两种方法，BEV-SB在每位患者中的治疗过程可回顾性地分为三个阶段：第1阶段，从BEV-SB初次出现至初次EIS；第2阶段，从初次EIS至初次IR治疗；第3阶段，从初次IR至2023年12月。进行描述性统计以明确各阶段的输血情况。
在519例被诊断为PH的患者中，有4例被确定为患有BEV-SB。每个阶段的治疗时长分别为20人月、42人月和77人月。这4例患者分别接受了8人次和5人次的EIS和IR治疗。所有患者在首次EIS后均出现反复胃肠道出血，但在IR治疗后未观察到进一步的胃肠道出血情况。各阶段输注的红细胞分别为34单位、31单位和3.5单位，血浆分别为13单位、14单位和1单位。
EIS可能对BEV-SB止血有效，但再出血很常见，旨在降低门静脉压力梯度的IR可能会降低再出血率。
