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Incidence and fate of antral varices
S R Shah1, C S Desai, S K Mathur
1Gastroenterology Surgical Services, King Edward VII Memorial Hospital, Bombay, India. shahsudeep@hotmail.com
Objective:
To study the incidence of antral varices (AV) and their fate in patients with portal hypertension so as to formulate a management policy.
Design:
Prospective cohort study.
Setting:
Single surgical unit specializing in portal hypertension management in a tertiary level centre.
Participants:
Three hundred and seventy-one patients [cirrhosis 170, non-cirrhotic portal fibrosis (NCPF) 53, extrahepatic portal venous obstruction (EHPVO) 148] with history of bleeding from oesophageal varices were inducted in the chronic sclerotherapy programme.
Interventions:
Protocol-based endoscopic sclerotherapy and management of bleeding for oesophageal varices.
Outcome Measures:
Development or disappearance of AV, bleeding from AV.
Results:
No patient had AV on index endoscopy. Thirteen (3.5%) patients developed AV, in cirrhosis 2.9%, EHPVO 4.1%, NCPF 3.8% (P = 0.86). AV developed after a mean of 15 months. Oesophageal varices took a longer number of sessions to obliterate in patients with AV (11.1 vs 5.98 sessions, P<0.0001). Only one patient bled, having coexistent oesophageal varices and gastropathy. AV disappeared spontaneously in seven patients, recurring in only one. Of seven persisting AV, none have bled over a mean follow-up of 30 months (SD 23.2).
Conclusions:
AV are seen in a small proportion of patients, and are distributed equally amongst the aetiologies of portal hypertension. They rarely bleed and may be ignored during sclerotherapy of oesophageal varices.