Prognostic significance of the white nipple sign in variceal bleeding

Gastrointest Endosc. Jan-Feb 1991;37(1):51-5. doi: 10.1016/s0016-5107(91)70621-4.


The prognostic significance of the white nipple sign in variceal bleeding was evaluated prospectively in 203 separate admissions for bleeding esophageal varices in 145 cirrhotic patients. During all admissions a standardized protocol of management defined the failure of transfusion and vasoactive drugs (conservative measures) to stop bleeding and the occurrence of early rebleeding, at which time either emergency sclerotherapy or a staple transection of the esophagus was used. The finding of a white nipple in 18 admissions (9%) did not have predictive value as regards the failure of conservative measures to stop bleeding within 24 hours or rebleeding within 5 days, and there was no association with increased mortality. In one case, a white nipple was seen to occur after spontaneous cessation of a variceal venous spurt, suggesting it is a platelet-fibrin plug. The white nipple sign is diagnostic of a varix that has bled but has no adverse prognostic significance.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Blood Transfusion
  • Esophageal and Gastric Varices / diagnosis*
  • Esophageal and Gastric Varices / mortality
  • Esophageal and Gastric Varices / therapy
  • Esophagoscopy
  • Female
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / therapy
  • Humans
  • Male
  • Multivariate Analysis
  • Prognosis
  • Prospective Studies
  • Regression Analysis
  • Sclerotherapy
  • Vasoconstrictor Agents / therapeutic use


  • Vasoconstrictor Agents