Positive white nipple sign on esophageal varices: Not a just bystander; our experience

Background and study aims The goal of this study was to assess whether a white nipple sign on esophageal varices is of no prognostic significance or mandates more attention. Patients and methods We retrospectively analyzed data from 2601 patients undergoing upper gastrointestinal endoscop...

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Autores principales:	Ritesh Prajhapati, Mohit Sethia, Pankaj Desai, Mayank Kabrawala, Rajiv Mehta, Subhash Nandwani, Chintan Patel, Nisharg Patel
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/3652c492a2124904816000a867889dbb
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spelling	oai:doaj.org-article:3652c492a2124904816000a867889dbb2021-11-13T00:00:31ZPositive white nipple sign on esophageal varices: Not a just bystander; our experience2364-37222196-973610.1055/a-1578-2223https://doaj.org/article/3652c492a2124904816000a867889dbb2021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1578-2223https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background and study aims The goal of this study was to assess whether a white nipple sign on esophageal varices is of no prognostic significance or mandates more attention. Patients and methods We retrospectively analyzed data from 2601 patients undergoing upper gastrointestinal endoscopy for variceal bleed from January 2008 to January 2020. Intraprocedural events like onset of active spurt while performing endoscopy, active spurt while attempting to band the varix with a nipple, need for rescue glue therapy required to control bleed in cases of failed endoscopic variceal ligation (EVL), slipping of band and rebleed despite successful band application, need for emergency intubation, and pulmonary aspiration-related complications were noted. Results A total of 2601 patients underwent endoscopy for variceal bleeding. Of them, 631 had a positive white nipple sign. Of that subgroup, 137 (21.7 %) patients developed active spurt during endoscopy. In patients with the white nipple sign, 12.3 % required endotracheal intubation and 6.7 % developed aspiration pneumonia, which were significantly higher than in those without the sign. Rescue glue injection in esophageal varices was needed in 5.6 % as compared to 0.6 % in those without white nipple. Conclusions The white nipple sign is not only a predictor of recent bleed, but it carries statistically significant increased risk of intraoperative bleeding, need for endotracheal intubation, esophageal glue injections, and aspiration-related complications. Therefore, it is not just a bystander, but rather, a sign of increased danger and a need to be more vigilant with patient management.Ritesh PrajhapatiMohit SethiaPankaj DesaiMayank KabrawalaRajiv MehtaSubhash NandwaniChintan PatelNisharg PatelGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1837-E1840 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Ritesh Prajhapati Mohit Sethia Pankaj Desai Mayank Kabrawala Rajiv Mehta Subhash Nandwani Chintan Patel Nisharg Patel Positive white nipple sign on esophageal varices: Not a just bystander; our experience
description	Background and study aims The goal of this study was to assess whether a white nipple sign on esophageal varices is of no prognostic significance or mandates more attention. Patients and methods We retrospectively analyzed data from 2601 patients undergoing upper gastrointestinal endoscopy for variceal bleed from January 2008 to January 2020. Intraprocedural events like onset of active spurt while performing endoscopy, active spurt while attempting to band the varix with a nipple, need for rescue glue therapy required to control bleed in cases of failed endoscopic variceal ligation (EVL), slipping of band and rebleed despite successful band application, need for emergency intubation, and pulmonary aspiration-related complications were noted. Results A total of 2601 patients underwent endoscopy for variceal bleeding. Of them, 631 had a positive white nipple sign. Of that subgroup, 137 (21.7 %) patients developed active spurt during endoscopy. In patients with the white nipple sign, 12.3 % required endotracheal intubation and 6.7 % developed aspiration pneumonia, which were significantly higher than in those without the sign. Rescue glue injection in esophageal varices was needed in 5.6 % as compared to 0.6 % in those without white nipple. Conclusions The white nipple sign is not only a predictor of recent bleed, but it carries statistically significant increased risk of intraoperative bleeding, need for endotracheal intubation, esophageal glue injections, and aspiration-related complications. Therefore, it is not just a bystander, but rather, a sign of increased danger and a need to be more vigilant with patient management.
format	article
author	Ritesh Prajhapati Mohit Sethia Pankaj Desai Mayank Kabrawala Rajiv Mehta Subhash Nandwani Chintan Patel Nisharg Patel
author_facet	Ritesh Prajhapati Mohit Sethia Pankaj Desai Mayank Kabrawala Rajiv Mehta Subhash Nandwani Chintan Patel Nisharg Patel
author_sort	Ritesh Prajhapati
title	Positive white nipple sign on esophageal varices: Not a just bystander; our experience
title_short	Positive white nipple sign on esophageal varices: Not a just bystander; our experience
title_full	Positive white nipple sign on esophageal varices: Not a just bystander; our experience
title_fullStr	Positive white nipple sign on esophageal varices: Not a just bystander; our experience
title_full_unstemmed	Positive white nipple sign on esophageal varices: Not a just bystander; our experience
title_sort	positive white nipple sign on esophageal varices: not a just bystander; our experience
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/3652c492a2124904816000a867889dbb
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Positive white nipple sign on esophageal varices: Not a just bystander; our experience

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