Liu J, Wang P, Wang LM, Guo J, Zhong N. Outcomes of endoscopic sclerotherapy for jejunal varices at the site of choledochojejunostomy (with video): Three case reports. World J Gastroenterol 2024; 30(14): 2059-2067 [PMID: 38681128 DOI: 10.3748/wjg.v30.i14.2059]
Corresponding Author of This Article
Ning Zhong, MD, PhD, Professor, Department of Gastroenterology, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan 250012, Shandong Province, China. nathan.zhongning@foxmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2024; 30(14): 2059-2067 Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.2059
Outcomes of endoscopic sclerotherapy for jejunal varices at the site of choledochojejunostomy (with video): Three case reports
Jun Liu, Peng Wang, Li-Mei Wang, Jing Guo, Ning Zhong
Jun Liu, Peng Wang, Li-Mei Wang, Jing Guo, Ning Zhong, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Liu J designed the research study; Liu J and Wang P analyzed the data and wrote the manuscript; Wang LM and Guo J performed the primary literature and data extraction; Zhong N was responsible for revising the manuscript; and all authors read and approved the final version.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning Zhong, MD, PhD, Professor, Department of Gastroenterology, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan 250012, Shandong Province, China. nathan.zhongning@foxmail.com
Received: January 2, 2024 Peer-review started: January 2, 2024 First decision: January 30, 2024 Revised: February 9, 2024 Accepted: March 26, 2024 Article in press: March 26, 2024 Published online: April 14, 2024 Processing time: 101 Days and 6.5 Hours
Abstract
BACKGROUND
Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established.
CASE SUMMARY
We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death.
CONCLUSION
We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
Core Tip: This is the first series of case reports on endoscopic sclerotherapy for venous varices at the choledochojejunostomy, including videos. From the experiences of our center, endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection may be considered as an easy, cost-effective and efficient treatment option for hemorrhage from venous varices at the choledochojejunostomy site. For patients without complications, underlying diseases, and significant organ dysfunction, as well as those who have undergone pancreaticoduodenectomy for benign diseases, endoscopic sclerotherapy tends to have better outcomes.
