Duodenal varices and evaluation of endoscopic cyanoacrylate injection for treatment of duodenal variceal bleeding

Background and aims

Duodenal varices (DVs) are a rare complication of portal hypertension. This study analyzed the clinical characteristics of DVs and examined the efficacy of endoscopic cyanoacrylate injection for duodenal variceal bleeding.

Methods

The clinical data of patients with DVs treated in our hospital from March 2013 to May 2024 were retrospectively analyzed.

Results

During the study period, 80,850 patients underwent gastroscopy for a total of 122,040 endoscopy sessions. DVs were diagnosed in 52 patients. Eight patients with DVs exhibited duodenal variceal bleeding (15.4%). The overall prevalence of DVs was 0.08%.The prevalence of DVs among patients with upper gastrointestinal varices was 0.16%. The most common etiology of DVs was liver cirrhosis (92.3%). DVs location was the descending segment of the duodenum in 34 patients (65.4%). Forty-four patients (84.6%) had concomitant esophageal and gastric varices. Successful hemostasis was achieved at the time of endoscopy in all patients undergoing emergency endoscopic treatment using cyanoacrylate injection. The 6-week mortality rate was 12.5%. The rebleeding rate was 12.5%.

Conclusions

DVs are uncommon, even in hospitals where liver disease is prevalent. Emergency endoscopic cyanoacrylate embolization appears to be highly effective. Complete vein embolization may be considered for patients in poor condition. Age >65 years and low hemoglobin concentration are predictors of duodenal variceal bleeding.