title: Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.
abstract: BACKGROUND
  Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results.
  
  
  METHODS
  We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years.
  
  
  METHODS
  All patients were diagnosed with liver cirrhosis presenting melena or hematemesis.
  
  
  METHODS
  All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case).
  
  
  RESULTS
  Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case.
  
  
  CONCLUSIONS
  EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine Department of Surgery, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Eunae
authors.initials: E
authors.lastname: Cho
authors.forename: Chung Hwan
authors.initials: CH
authors.lastname: Jun
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Rew
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
authors.forename: Hee Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Mingui
authors.initials: M
authors.lastname: Han
authors.forename: Kyu Man
authors.initials: KM
authors.lastname: Cho
mesh_terms: D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates