Incidence and fate of antral varices

Objective To study the incidence of antral varices (AV) and their fate in p atients with portal hypertension so as to formulate a management policy. Design Prospective cohort study. Setting Single surgical unit specializing in portal hypertension management in a tertiary level centre. Participants Three hundred and seventy-one patients [cirrhosis 170, non-cir rhotic portal fibrosis (NCPF) 53, extrahepatic portal venous obstruction (E HPVO) 148] with history of bleeding from oesophageal varices were inducted in the chronic sclerotherapy programme. Interventions Protocol-based endoscopic sclerotherapy and management of ble eding for oesophageal varices. Outcome measures Development or disappearance of AV, bleeding from AV. Results No patient had AV on index endoscopy. Thirteen (3.5%) patients deve loped AV, in cirrhosis 2.9%, EH PVO 4.1%, NCPF 3.8%(P = 0.86). AV developed after a mean of 15 months. Oesophageal varices took a longer number of ses sions to obliterate in patients with AV (11.1 vs 5.98 sessions, P< 0.0001). Only one patient bled, having coexistent oesophageal varices and gastropat hy. AV disappeared spontaneously in seven patients, recurring in only one. Of seven persisting AV, none have bled over a mean follow-up of 30 months ( SD 23.2). Conclusions AV are seen in a small proportion of patients, and are distribu ted equally amongst the aetiologies of portal hypertension. They rarely ble ed and may be ignored during sclerotherapy of oesophageal varices. fur I Ga stroenterol Hepatol 11:1041-1043 (C) 1999 Lippincott Williams & Wilkins.