Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5620-5633
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5620
Difference between type 2 gastroesophageal varices and isolated fundic varices in clinical profiles and portosystemic collaterals
Yu-Hu Song, Hong-Yu Xiang, Ke-Ke Si, Ze-Hui Wang, Yu Zhang, Chang Liu, Ke-Shu Xu, Xin Li
Yu-Hu Song, Hong-Yu Xiang, Ze-Hui Wang, Chang Liu, Ke-Shu Xu, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Ke-Ke Si, Yu Zhang, Xin Li, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Ke-Ke Si, Yu Zhang, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Li X and Xiang HY contributed equally to this work; Song YH designed the study; Li X, Xiang HY, Si KK, Wang ZH and Song YH performed the research and collected data; Xiang HY, Li X and Song YH wrote the paper; Li X, Xiang HY, Si KK, Wang ZH, Liu C, Song YH, Xu KS, Song YH analyzed the data, reviewed the chart; Xiang HY, Si KK, Wang ZH, Liu C and Song YH performed statistical analysis.
Supported by National Natural Science Foundation of China, No. 82070631.
Institutional review board statement: The study was conducted according to the principles of the Declaration of Helsinki, and the protocol was approved by the ethics committee of Tongji Medical College, Huazhong University of Science and Technology (No. 2020-S216) and registered at www.chictr.org.cn (ChiCTR 2100042267).
Informed consent statement: The requirement for informed consent was waived because of retrospective study.
Conflict-of-interest statement: All authors have nothing to disclose
Data sharing statement: All authors had access to the study data and reviewed and approved the final manuscript.
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: Xin Li, MD, PhD, Chief Doctor, Professor, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. lxwsry2014@163.com
Received: December 8, 2021
Peer-review started: December 8, 2021
First decision: March 11, 2022
Revised: March 17, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
Processing time: 182 Days and 14.7 Hours
Abstract
BACKGROUND

There is significant heterogeneity between gastroesophageal varices (GOV2) and isolated gastric varices (IGV1). The data on the difference between GOV2 and IGV1 are limited.

AIM

To determine the etiology, clinical profiles, endoscopic findings, imaging signs, portosystemic collaterals in patients with GOV2 and IGV1.

METHODS

Medical records of 252 patients with gastric fundal varices were retrospectively collected, and computed tomography images were analyzed.

RESULTS

Significant differences in routine blood examination, Child–Pugh classification and MELD scores were found between GOV2 and IGV1. The incidence of peptic ulcers in patients with IGV1 (26.55%) was higher than that of GOV2 (11.01%), while portal hypertensive gastropathy was more commonly found in patients with GOV2 (22.02%) than in those with IGV1 (3.54%). Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1. In patients with GOV2, the main afferent vessels were via the left gastric vein (LGV) (97.94%) and short gastric vein (SGV) (39.18%). In patients with IGV1, the main afferent vessels were via the LGV (75.61%), SGV (63.41%) and posterior gastric vein (PGV) (43.90%). In IGV1 patients with pancreatic diseases, spleno-gastromental-superior mesenteric shunt (48.15%) was a major collateral vessel. In patients with fundic varices, the sizes of gastric/esophageal varices were positively correlated with afferent vessels (LGVs and PGVs) and efferent vessels (gastrorenal shunts). The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients.

CONCLUSION

Significant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.

Keywords: Gastrorenal shunt; Spleno-gastroomental-superior mesenteric shunt; Liver cirrhosis; Pancreatic diseases

Core Tip: These findings highlight the differences in the etiology, clinical profiles, endoscopic findings, imaging signs, portosystemic collaterals between patients with gastroesophageal varices and patients with isolated gastric varices. Knowledge of the etiology and portosystemic collaterals in our study is helpful in making therapeutic decisions.