title: Clinical characteristics and treatment for patients presenting with bleeding duodenal varices.
abstract: OBJECTIVE
  Bleeding from ectopic varices, including duodenal varices, is uncommon, but it can be difficult to manage. The clinical data of patients diagnosed and treated for duodenal varices were reviewed to investigate the strategy for treatment.
  
  
  METHODS
  The present study reviewed the clinical data of 10 patients with duodenal varices (mean age, 58.2 ± 15.6 years) at our associated institutes during the period between January 1996 and December 2008.
  
  
  RESULTS
  Nine patients had duodenal varices located in the second portion, whereas in one case they were located in the duodenal bulbus. The underlying diseases included liver cirrhosis in eight patients, and extrahepatic portal vein obstruction in two patients. The lesions were identified with bleeding from varices in eight of 10 patients. Initial hemostasis was achieved in all eight patients. However, among four patients treated endoscopically only, two patients died from rebleeding from varices and two died from hepatic failure resulting from variceal bleeding. Additional interventional radiology (IVR) was used in three patients and additional surgery was carried out in one case. One patient who was treated with balloon-occluded retrograde transvenous obliteration rebled during IVR and died from bleeding. Two patients who underwent double balloon-occluded embolotherapy and one case who had surgery achieved good clinical outcomes.
  
  
  CONCLUSIONS
  Although endoscopic treatment is useful for initial hemostasis of hemorrhagic duodenal varices, the patients who underwent additional IVR after endoscopic treatment achieved good outcomes.
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma, Japan. kakizaki@showa.gunma-u.ac.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Toyoda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Arai
authors.forename: Naondo
authors.initials: N
authors.lastname: Sohara
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Iizuka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Onozato
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods; D004378:Duodenal Diseases / Q000628:therapy*; D004384:Duodenoscopy / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006488:Hemostasis, Surgical; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D016896:Treatment Outcome