Farah Deshmukh, MD, Peter Francisco, MD; Bassett Medical Center, Cooperstown, NY
Introduction: Isolated proximal esophageal varices also known as “downhill” esophageal varices are an unusual finding with an incidence of approximately 0.4% to 10% of all acute esophageal variceal bleeds. They are generally associated with portal hypertension or superior vena cava obstruction due to mediastinal masses such as lung cancer, thymoma or lymphoma. Proximal esophageal varices are rarely seen in the absence of these etiologies.
Methods: An 87-year-old male with congestive heart failure and no history of liver disease or chronic alcohol use presented with acute lower gastrointestinal bleed. Gastrointestinal work up involved colonoscopy that showed diverticulosis and upper endoscopy that revealed non-bleeding grade I to II proximal esophageal varices. There was no evidence of distal esophageal varices, gastric varices or gastric antral vascular ectasia (GAVE). Computed tomography scan of the chest was done to assess for any vascular compromise that may explain the proximal esophageal varices, however, the scan was unremarkable and did not reveal any anatomical or vascular abnormalities. The patient was managed with close follow-up and repeat endoscopy was not recommended due to his advanced age. Discussion: The pathophysiology and management of proximal esophageal varices is different from distal esophageal varices. Superior vena cava obstruction secondary to a mediastinal mass accounts for approximately 30% of the cases of proximal esophageal varices and these can be managed with temporary banding, balloon angioplasty or surgical intervention. Isolate proximal esophageal varices in the absence of an underlying etiology are rarely seen and its management is thus not well studied.
Disclosures: Farah Deshmukh indicated no relevant financial relationships. Peter Francisco indicated no relevant financial relationships.