title: Prognostic significance of the white nipple sign in variceal bleeding.
abstract: The prognostic significance of the white nipple sign in variceal bleeding was evaluated prospectively in 203 separate admissions for bleeding esophageal varices in 145 cirrhotic patients. During all admissions a standardized protocol of management defined the failure of transfusion and vasoactive drugs (conservative measures) to stop bleeding and the occurrence of early rebleeding, at which time either emergency sclerotherapy or a staple transection of the esophagus was used. The finding of a white nipple in 18 admissions (9%) did not have predictive value as regards the failure of conservative measures to stop bleeding within 24 hours or rebleeding within 5 days, and there was no association with increased mortality. In one case, a white nipple was seen to occur after spontaneous cessation of a variceal venous spurt, suggesting it is a platelet-fibrin plug. The white nipple sign is diagnostic of a varix that has bled but has no adverse prognostic significance.
authors.affiliation: Hepato-biliary and Liver Transplantation Unit, Royal Free Hospital and School of Medicine, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Siringo
authors.forename: P A
authors.initials: PA
authors.lastname: McCormick
authors.forename: P
authors.initials: P
authors.lastname: Mistry
authors.forename: G
authors.initials: G
authors.lastname: Kaye
authors.forename: N
authors.initials: N
authors.lastname: McIntyre
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D015911:Sclerotherapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents