What are esophageal varicose veins?
They are abnormally large or dilated veins found in the final portion of the esophagus. The dilation happens due to slow blood flow through the liver as a result of sickness. The main cause of concern with varicose veins is the risk of rupture and hemorrhage that could be fatal. The possibility of bleeding is increased in patients with more severe liver disease
The development of esophageal varicose veins is progressive. Nearly 50% of patients with cirrhosis have varicose veins at the time the liver disease is detected. Varicose veins may begin small but they have a 10% risk of increasing in size each year. Approximately a third of patients with large, untreated varicose veins present bleeding within 2 years.
What are the symptoms?
Varicose veins do not have associated symptoms. Hemorrhage is usually made evident by dark feces with or without blood in vomit. Frequently the patient presents symptoms associated with sudden blood loss, such as dizziness, paleness, and loss of consciousness.
How are they diagnosed?
Intentional endoscopic examination after being diagnosed with cirrhosis is the most effective path to detection. The endoscopy consists of introducing a flexible scope into the body through the mouth. Visual examination through endoscopy allows the physician to determine the location, size, and width of the vein walls. In the case of not finding varicose veins after the detection of cirrhosis, it is important to have an endoscopic examination once every year. Small varicose veins also require yearly control examinations to monitor any possible increase in size. In case of large varicose veins, it is recommended to begin treatment before any bleeding. Signs of bleeding or sudden blood loss can be an indication for the need of an endoscopic examination.
Images of endoscopic view of varicose veins.
What is the treatment?
The treatment depends on the associated circumstances.
1. Patients with varicose veins without previous bleeding. In the case of finding large varicose veins, it is recommended to begin treatment as soon as possible with endoscopic ligation. This technique consists in strangling the varicose veins with the use of rubber bands placed by means of endoscopy. The objective of this method is to diminish the size of the veins. Generally more than one session are necessary to complete the treatment.
Endoscopic ligation of varicose veins.
2. Hemorrhage. This is considered a medical emergency and must be treated immediately. In this case the treatment is aimed at controlling the hemorrhage as well as the prevention of complications associated with bleeding. This can be accomplished by the use of drugs that reduce the blood pressure within the varicose veins, or endoscopic treatment by ligation of the veins or sclerotherapy. Recent studies suggest the complementary use of both methods.
Sclerotherapy by endoscopy.
3. Prevention of future hemorrhage. Patients who have experienced bleeding have a 70% chance of a second hemorrhage within the next year. In order to reduce the risk, it is necessary to resort to drug therapy or endoscopic treatment.
Ligation by endoscopy.