Endoscopic Differences of Gastric Cardiac Varices from Fundal Varices in Acute Bleeding

摘要

Background: There were two distinct subsets of gastric varices; varices distal to the gastroesophageal junction without extension into the fundus "cardiac varices" and varices that extend from the cardia to the fundus or exist only in the fundus "fundal varices". Patients with fundal varices have large gastrorenal shunts associated with a lower portal pressure in comparison with patients with cardiac varices. We therefore hypothesized that endoscopic findings of bleeding from the two types of gastric varices might be different. Aims: To characterize endoscopic findings of bleeding cardiac varices and fundal varices. Methods: Between January 1990 and October 2005, 459 patients with bleeding esophagaeal and gastric varices admitted to Kurume university hospital. Among them, 231 patients with bleeding gastric varices were retrospectively enrolled in this study. In all patients, endoscopic examinations were performed to confirm the location of the bleeding. The size of gastric varices was graded as follows: Fl (straight or winding), F2 (nodular), F3 (tumorous). For the data analysis, Fl was scored as 1, F2 as 2, and F3 as 3. Results: There were 151 males and 80 females, with a mean age of 60. The cause of portal hypertension was due to cirrhosis (alcoholic cirrhosis in 24 patients, posthepatitic cirrhosis in 174, primary biliary cirrhosis in five, and others in 28. The mean Pugh-Child score was 8.6. 109 patients bled from the cardiac varices and 122 patients from the fundal varices. The size of varices was significantly smaller in cardiac varices than in fundal varices (1.4 + 0.7 vs. 2.5 +- 0.6,P < 0.001). The prevalence of red color sign was significantly higher in cardiac vartces than in fundal varices (2896 vs. 11%, P < 0.01). In contrast, the prevalence of ulcer on varix was significantly higher in fundal varices than in cardiac varices (34% vs. 6%, P < 0.001). Conclusions: Endoscopic findings of bleeding cardiac varices are different from those of fundal varices. Red color sign may be an important endoscopic factor in rupture of cardiac varices. In contrast, size of varices and ulceration may be important endoscopic factors in rupture of fundal varices.