Endoscopic Treatment for Anastomotic Varices after Choledochojejunostomy

Ectopic varices are defined as portosystemic venous collaterals occurring anywhere in the gastrointestinal tract other than the esophagogastric region. Anastomotic varices after choledochojejunostomy should be considered when evaluating gastrointestinal hemorrhage in patients with previous surgery and mesenteric venous hypertension. Hemorrhaging from varices in the jejunal loop [1], with extrahepatic portal vein obstruction after choledochojejunostomy, is a rare condition but several articles have been published. Various medical treatments, such as interventional radiology and surgery, have been used to control bleeding from anastomotic varices after choledochojejunostomy; however, there is no best treatment strategy for anastomotic varices. Anastomotic varices after choledochojejunostomy drain directly into the intrahepatic portal vein. Therefore, endoscopic treatment is difficult for this condition and endoscopic obliterative therapy with N-butyl-2-cyanoacrylate is the preferred treatment for this type varices [1,2].