Isolated fundic varices in liver cirrhosis

Isolated fundic varices in liver cirrhosis is a rare clinical manifestation. There is much controversy over their bleeding risk, therapy and outcome. We studied two subtypes of isolated fundic varices and assessed their relative risks of variceal bleeding, degree of bleeding and 42-day mortality. From 1992 to 1995, 26 patients presenting with isolated fundic varices (16 primary and 10 secondary) with liver cirrhosis as the underlying disease were included. Patients with segmental portal hypertension were excluded from this study. The endoscopic features and grades of cirrhosis at first presentation were recorded. During follow-up, endoscopic examinations were performed at the time of upper gastrointestinal bleeding to ascertain fundic variceal bleeding. No differences in the clinical characteristics were noted between these two groups of patients. The relative risk for isolated fundic variceal bleeding for the primary group was 0.246, while that for the secondary group was 0.224. Total amounts of blood transfused were 6.3 units per patient for the primary group and 15.0 units for the secondary group. Forty-two day mortalities were 33.3% and 75.0% respectively. Only Child B and C cirrhotic patients with F2 or F3 varices had bleeding. No correlation was found between the bleeding risk and endoscopic red color sign in these two groups. Although the relative risk for isolated fundic variceal bleeding appeared similar in both groups, patients with secondary isolated fundic varices tended to have more severe bleeding and thus a poorer prognosis. In our study, variceal bleeding only occurred in patients with Child B or C cirrhosis and F2 or F3 varices, and endoscopic red color sign had no significant role in isolated fundic varices bleeding.