Table 1

Summary of risks and benefits of the current therapeutic options in management of duodenal varices

Therapeutic optionsBenefitsRisks
EndoscopicVariceal banding
  • Relatively non-invasive23

  • Reported success2 14 17 22 24

  • Risk of recurrence

  • Rebleeding rate high24

  • Can cause wider defect1 2 6 22

  • Visualisation difficult1 2 6 22

Variceal sclerotherapy
  • Relatively non-invasive23

  • Reported success3 13 20 21 24

  • Tissue damage3 6 17 24

  • Ulceration3 6 17 24

  • Perforation3 6 17 24

  • Risk of pulmonary embolism of sclerosant3 6 17 24

  • Visualisation difficult3 6 17 24

Interventional radiologyTransjugular intrahepatic portosystemic shunt (TIPSS)
  • Very effective

  • Option in poor surgical candidate6 25

  • Option in refractory cases6 25

  • Decrease portosystemic pressure gradient6 25

  • Hepatic encephalopathy6 25

  • Stenosis of stent common (55–70%)6 25

Balloon occluded retrograde transvenous obliteration (BRTO)
  • Management for life-threatening bleeding14 24

  • Recanalisation or development of collaterals14 24

SurgicalVariceal ligation
  • For cases refractory to endoscopic intervention7 14

  • Rebleeding rate high7 14

  • Risk of further management7 14

  • Invasive7 14

Duodenectomy
  • For cases refractory to endoscopic intervention7 14

  • Rebleeding rate high7 14

  • Risk of further management

  • Invasive7 14

Shunt surgery
  • Little risk of rebleeding7 14

  • Decrease portosystemic pressure gradient7 14

  • 30% mortality rate6

  • Require good hepatic function7 14

  • Invasive7 14