Study of the association between hemorrhage and the position of hemorrhagic stigmata in patients with esophageal varices

Shen,Shao‑Hua; Liu,Ying‑Di; Sun,Xiao; Li,Meng; Sun,Guo‑Hui; Wang,Juan; Liu,Jiang‑Tao; Tie,Jun; Yang,Jing

doi:10.3892/etm.2017.4727

September-2017 Volume 14 Issue 3

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September-2017 Volume 14 Issue 3

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Article

Study of the association between hemorrhage and the position of hemorrhagic stigmata in patients with esophageal varices

Authors:
- Shao‑Hua Shen
- Ying‑Di Liu
- Xiao Sun
- Meng Li
- Guo‑Hui Sun
- Juan Wang
- Jiang‑Tao Liu
- Jun Tie
- Jing Yang
View Affiliations / Copyright

Affiliations: Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China, Department of Gastroenterology, Hainan Branch of PLA General Hospital, Sanya, Hainan 572000, P.R. China, Department of Gastroenterology and Hepatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
Pages: 2261-2264
|
Published online on: July 9, 2017

https://doi.org/10.3892/etm.2017.4727
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Abstract

The aim of the present study was to investigate the predilection position of hemorrhagic stigmata (HS) in patients with esophageal variceal hemorrhage and provide guidance on endoscopic therapy for esophageal varices. The clinical characteristics, particularly the endoscopic manifestations of HS, in the patients who presented with gastroesophageal variceal hemorrhage and cirrhosis between January 2003 and December 2013 at our hospital were summarized and patients were grouped according to the distance of the lesion site to incisors at 35‑40 and ~30 cm. The association between the location of HS and active hemorrhage was assessed. The location of hemorrhage and HS at 35‑40 cm from the incisors was more common in esophageal varices patients, followed by the location at ~30 cm from the incisors (P<0.0001). The incidence of HS in esophageal varices patients in the 35‑40 cm group was significantly higher than that in the ~30 cm group except for HS at 9:00 position (P<0.0001). The highest incidence of HS in the ~30 cm group was at the 3:00 position, followed by the 12:00, 6:00 and 9:00 position. Among them, there were significant differences between the 3:00 and 6:00 position, the 3:00 and 9:00 position, and the 9:00 and 12:00 position (P<0.05). The order in the 35‑40 cm group was similar to that in the ~30 cm group and the incidence of HS at the 9:00 position was lowest (P<0.05). A certain association between the point of location of HS and hemorrhage was identified. HS located at 35‑40 cm from the lesion site to incisors was identified to be most likely to bleed, followed by that located at ~30 cm. In addition, the incidence of HS at 9:00 position was found to be lower than that in the other positions. Therefore, HS located at ~30 cm and 35‑40 cm from the lesion site to incisors should be paid attention to and the 3:00, 12:00 and 6:00 rather than the 9:00 position should be prioritized during endoscopic treatment, particularly in emergency situations.

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1	Sakamoto Y, Oho K, Toyonaga A, Kumamoto M, Haruta T, Inoue H, Emori K, Tsuruta O and Sata M: Effect of Helicobacter pylori infection on esophagogastric variceal bleeding in patients with liver cirrhosis and portal hypertension. J Gastroenterol Hepatol. 28:1444–1449. 2013. View Article : Google Scholar : PubMed/NCBI
2	Narváez-Rivera RM, Cortez-Hernández CA, González-González JA, Tamayo-de la Cuesta JL, Zamarripa-Dorsey F, Torre-Delgadillo A, Rivera-Ramos JF, Vinageras-Barroso JI, Muneta-Kishigami JE, Blancas-Valencia JM, et al: Mexican consensus on portal hypertension. Rev Gastroenterol Mex. 78:92–113. 2013.(In Spanish). PubMed/NCBI
3	Peck-Radosavljevic M, Angermayr B, Datz C, Ferlitsch A, Ferlitsch M, Fuhrmann V, Häfner M, Kramer L, Maieron A, Payer B, et al: Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II). Wien Klin Wochenschr. 125:200–219. 2013. View Article : Google Scholar : PubMed/NCBI
4	Dworzynski K, Pollit V, Kelsey A, Higgins B and Palmer K: Guideline Development Group: Management of acute upper gastrointestinal bleeding: Summary of NICE guidance. BMJ. 344:e34122012. View Article : Google Scholar : PubMed/NCBI
5	Cremers I and Ribeiro S: Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis. Therap Adv Gastroenterol. 7:206–216. 2014. View Article : Google Scholar : PubMed/NCBI
6	Boyce HW: The normal anatomy around the oesophagogastric junction: An endoscopic view. Best Pract Res Clin Gastroenterol. 22:553–567. 2008. View Article : Google Scholar : PubMed/NCBI
7	Vianna A, Hayes PC, Moscoso G, Driver M, Portmann B, Westaby D and Williams R: Normal venous circulation of the gastroesophageal junction. A route to understanding varices. Gastroenterology. 93:876–889. 1987. View Article : Google Scholar : PubMed/NCBI
8	Sharma M and Rameshbabu CS: Collateral pathways in portal hypertension. J Clin Exp Hepatol. 2:338–352. 2012. View Article : Google Scholar : PubMed/NCBI
9	Butler H: The veins of the oesophagus. Thorax. 6:276–296. 1951. View Article : Google Scholar : PubMed/NCBI
10	Paquet KJ: Causes and pathomechanisms of oesophageal varices development. Med Sci Monit. 6:915–928. 2000.PubMed/NCBI
11	Aharinejad S, Böck P and Lametschwandtner A: Scanning electron microscopy of esophageal microvasculature in human infants and rabbits. Anat Embryol (Berl). 186:33–40. 1992. View Article : Google Scholar : PubMed/NCBI
12	Kutoglu T, Turut M, Kocabiyik N, Ozan H and Yildirim M: Anatomical analysis of azygos vein system in human cadavers. Rom J Morphol Embryol. 53:1051–1056. 2012.PubMed/NCBI
13	Shertsinger AG, Manuk'ian GV, Manuk'ian VG, Cherkasov VA, Zhigalova SB, Khovrin VV, Aliev KhKh and Tsaava DV: Pathogenesis of esophageal and gastric varicose veins formation in patients with liver cirrhosis. Eksp Klin Gastroenterol. 73–78. 2011.(In Russian). PubMed/NCBI
14	Ibukuro K, Tsukiyama T, Mori K and Inoue Y: Preaortic esophageal veins: CT appearance. AJR Am J Roentgenol. 170:1535–1538. 1998. View Article : Google Scholar : PubMed/NCBI
15	Zhao LQ, He W and Chen G: Characteristics of paraesophageal varices: A study with 64-row multidetector computed tomography portal venography. World J Gastroenterol. 14:5331–5335. 2008. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Study of the association between hemorrhage and the position of hemorrhagic stigmata in patients with esophageal varices

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