{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:53:45Z","timestamp":1760057625428,"version":"build-2065373602"},"reference-count":15,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]},{"name":"National Key Clinical Specialty Construction Project","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]},{"name":"National Natural Science Foundation of China","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]},{"name":"Beijing Research-Oriented Ward Excellence Clinical Research Program","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]},{"name":"Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences","award":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"],"award-info":[{"award-number":["2022-I2M-1-003","7232123","2022-PUMCH-B-023","ZK108000","32170788","82273726","BRWEP2024W034010100","2023-JKCS-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Ectopic varices account for 5% of variceal bleeding cases but carry high mortality due to their concealed nature and diagnostic challenges. A 46-year-old man with hepatitis C cirrhosis and prior gastroesophageal variceal bleeding presented with fatigue and dark red stools. Initial gastroscopy revealed moderate gastric\u2013oesophageal varices without active bleeding, treated with preventive sclerotherapy and cyanoacrylate injection. Persistent bleeding and a worsening condition led to his transfer to our hospital. Clinical evaluation suggested lower gastrointestinal bleeding. Imaging and colonoscopy confirmed ascending colon ectopic varices with recent thrombotic bleeding, while a repeated gastroscopy showed evidence of prior therapeutic interventions for gastric\u2013oesophageal varices, which were stable. A titanium clip was placed for temporary hemostasis, but further vascular embolization was halted due to extensive variceal involvement and risk of bowel necrosis. A multidisciplinary team recommended a transjugular intrahepatic portosystemic shunt, although the patient declined. This case underscores the importance of identifying the primary bleeding source to prevent exacerbation caused by unnecessary interventions. A stepwise diagnostic approach is put forward, highlighting that multidisciplinary care is crucial, with personalized, minimally invasive strategies to manage fragile vascular anatomy. Early detection and increased awareness of ectopic varices can facilitate timely and appropriate therapeutic interventions, ultimately improving patient care and outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics15040461","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T12:06:32Z","timestamp":1739448392000},"page":"461","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Less Could Be More: Rethinking the Unexpected Deterioration of Variceal Bleeding After Endoscopic Occlusion of Gastroesophageal Varices"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5890-7835","authenticated-orcid":false,"given":"Ke","family":"Pang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"},{"name":"Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2265-7092","authenticated-orcid":false,"given":"Kun","family":"He","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiyang","family":"Min","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"},{"name":"Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiwei","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Complex Severe and Rare Diseases, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9430-9874","authenticated-orcid":false,"given":"Dong","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1111\/j.1872-034X.2010.00690.x","article-title":"Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension","volume":"40","author":"Watanabe","year":"2010","journal-title":"Hepatol. Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Park, S.W., Cho, E., Jun, C.H., Choi, S.K., Kim, H.S., Park, C.H., Rew, J.S., Cho, S.B., Kim, H.J., and Han, M. (2017). Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review. Medicine, 96.","DOI":"10.1097\/MD.0000000000005860"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0016-5107(99)70498-0","article-title":"Successful management of ruptured duodenal varices by means of endoscopic variceal ligation: Report of a case","volume":"49","author":"Shiraishi","year":"1999","journal-title":"Gastrointest. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.4254\/wjh.v7.i30.2992","article-title":"Management of rectal varices in portal hypertension","volume":"7","author":"Laiyemo","year":"2015","journal-title":"World J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1055\/s-0029-1243840","article-title":"Endoscopic band ligation of rectal varices: A case series","volume":"42","author":"Baron","year":"2010","journal-title":"Endoscopy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1080\/00365520903030787","article-title":"Clinical characteristics and endoscopic treatment with cyanoacrylate injection in patients with duodenal varices","volume":"44","author":"Liu","year":"2009","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.gie.2010.02.054","article-title":"Massive lower GI bleed from an endoscopically inevident rectal varices: Diagnosis and management by EUS (with videos)","volume":"72","author":"Sharma","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"So, H., Park, D.H., Jung, K., and Ko, H.K. (2016). Successful Endoscopic Ultrasound-Guided Coil Embolization for Severe Duodenal Bleeding. Am. J. Gastroenterol., 111.","DOI":"10.1038\/ajg.2016.73"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E801","DOI":"10.1055\/a-2408-9639","article-title":"Never say never: A novel approach to tackle a bleeding ectopic varix","volume":"56","author":"Kulkarni","year":"2024","journal-title":"Endoscopy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"141","DOI":"10.4103\/eus.eus_63_20","article-title":"Refractory rectal variceal bleeding treated with EUS-guided coil embolization","volume":"10","author":"Rana","year":"2021","journal-title":"Endosc. Ultrasound"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sharma, M., Rai, P., and Bansal, R. (2013). EUS-Assisted Evaluation of Rectal Varices before Banding. Gastroenterol. Res. Pract., 2013.","DOI":"10.1155\/2013\/619187"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/qjmed\/hcae026","article-title":"New sights in ectopic varices in portal hypertension","volume":"117","author":"He","year":"2024","journal-title":"Qjm"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S2468-1253(23)00209-1","article-title":"Diagnosis and management of ectopic varices in portal hypertension","volume":"8","author":"Tranah","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases","volume":"65","author":"Abraldes","year":"2017","journal-title":"Hepatology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bhagani, S., Winters, C., and Moreea, S. (2017). Duodenal variceal bleed: An unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make. 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