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World J Hepatol. Dec 28, 2015; 7(30): 2992-2998
Published online Dec 28, 2015. doi: 10.4254/wjh.v7.i30.2992
Management of rectal varices in portal hypertension
Kawtar Al Khalloufi, Adeyinka O Laiyemo
Kawtar Al Khalloufi, Adeyinka O Laiyemo, Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, Washington, DC 20060, United States
Author contributions: All authors contributed to this manuscript.
Supported by The National Center for Advancing Translational Science, Nos. KL2TR000102-04 and UL1RT000101; the National Institute for Diabetes; Digestive Diseases and Kidney, No. R21DK100875; and National Institutes of Health.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: 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/
Correspondence to: Adeyinka O Laiyemo, MD, MPH, Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, United States. adeyinka.laiyemo@howard.edu
Telephone: +1-202-8657186 Fax: +1-202-8654607
Received: July 28, 2015
Peer-review started: July 29, 2015
First decision: September 29, 2015
Revised: October 13, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: December 28, 2015
Processing time: 152 Days and 2.8 Hours
Abstract

Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, their prevalence has been reported as high as 94% in patients with extrahepatic portal vein obstruction. The diagnosis is typically based on lower endoscopy (colonoscopy or sigmoidoscopy). However, endoscopic ultrasonography has been shown to be superior to endoscopy in diagnosing rectal varices. Color Doppler ultrasonography is a better method because it allows the calculation of the velocity of blood flow in the varices and can be used to predict the bleeding risk in the varices. Although rare, bleeding from rectal varices can be life threatening. The management of patients with rectal variceal bleeding is not well established. It is important to ensure hemodynamic stability with blood transfusion and to correct any coagulopathy prior to treating the bleeding varices. Endoscopic injection sclerotherapy has been reported to be more effective in the management of active bleeding from rectal varices with less rebleeding rate as compared to endoscopic band ligation. Transjugular intrahepatic portsystemic shunt alone or in combination with embolization is another method used successfully in control of bleeding. Balloon-occluded retrograde transvenous obliteration is an emerging procedure for management of gastric varices that has also been successfully used to treat bleeding rectal varices. Surgical procedures including suture ligation and porto-caval shunts are considered when other methods have failed.

Keywords: Rectal varices; Portal hypertension; Liver cirrhosis; Colonoscopy; Gastrointestinal bleeding

Core tip: Rectal varices complicate portal hypertension. Although rare, bleeding from rectal varices can be life threatening. There are no established guidelines for the treatment of rectal varices. In this article, the authors review endoscopic, radiological, and surgical techniques which have been suggested to be effective in the management of bleeding rectal varices.