[Upper esophageal varices. Study of 6 cases and review of the literature].

Distal esophageal varices are most frequently associated with portal hypertension, while varices of the upper esophagus are occasionally observed in patients with vena caval obstruction. One hundred and nineteen cases of upper esophageal varices (downhill varices) have been reported in the literature. We report 6 cases (4 men and 2 women), with vena caval obstruction. Upper gastrointestinal hemorrhage occurred in one patient. Endoscopy showed varices in the proximal third of the esophagus in 5 patients and in the proximal half of the esophagus in the other patient. Superior vena cavogram demonstrated total or partial occlusion of the vena cava in 6 cases, with opacification of the right azygos vein in 4 cases and thrombosis of this vein in one case. Superior vena caval obstruction was secondary to malignant lymphoma in 2 cases, to malignant thymoma in 2 cases, to malignant thyroid tumor in one case and to anaplastic bronchogenic carcinoma in one case. Clinical symptoms of vena caval obstruction are present in 91.4 p. 100 of the cases in the literature. Upper gastrointestinal hemorrhage are observed in 7.6 p. 100 of cases. It is generally agreed that the predominant factors involved in the determination of the downward extension of varices along the esophagus are the level of superior vena caval obstruction and its duration. Because of the risk of digestive hemorrhage and of the topographic meaning of the degree of extension, upper esophageal varices should be routinely searched in patients with vena caval hypertension.