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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1837-E1840
DOI: 10.1055/a-1578-2223
Original article

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

Ritesh Prajhapati
1   SIDS Hospital & Research Centre – Department of Gastroenterology & Hepatology, Surat, India
,
Mohit Sethia
2   SIDS Hospital & Research Centre – GI Endoscopy, Surat, India
,
Pankaj Desai
2   SIDS Hospital & Research Centre – GI Endoscopy, Surat, India
,
Mayank Kabrawala
1   SIDS Hospital & Research Centre – Department of Gastroenterology & Hepatology, Surat, India
,
Rajiv Mehta
1   SIDS Hospital & Research Centre – Department of Gastroenterology & Hepatology, Surat, India
,
Subhash Nandwani
1   SIDS Hospital & Research Centre – Department of Gastroenterology & Hepatology, Surat, India
,
Chintan Patel
2   SIDS Hospital & Research Centre – GI Endoscopy, Surat, India
,
Nisharg Patel
1   SIDS Hospital & Research Centre – Department of Gastroenterology & Hepatology, Surat, India
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Abstract

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.



Publication History

Received: 07 May 2021

Accepted: 28 July 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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