Linkedin

Gastric varices are present in 20% of patients with portal hypertension and are more common in patients with non-cirrhotic portal hypertension. The bleeding rate of gastric varices is lower comparing to esophageal varices. Nevertheless, bleeding is usually more severe and associated with higher mortality rates. The role of endoscopic management of gastric varices, particularly in the setting of prophylaxis, is debatable. Endoscopic variceal obliteration (EVO) with cyanoacrylate is the preferred endoscopic approach for acute bleeding episodes, as well as for primary or secondary prophylaxis. Trials comparing EVO with elastic band ligation (EBL) have suggest a higher effectiveness of EVO and significant rebleeding rates with elastic band ligation. However, current clinical practice is supported by very low-quality evidence.

We report the case of 60-year-old male undergoing palliative chemotherapy for pancreatic adenocarcinoma with invasion of the splenic vein and metastasis to the liver and peritoneum. The patient had a recent hospitalization due to upper gastrointestinal bleeding from gastric varices (Sarin Classification IGV 1), treated with EVO with cyanoacrylate in combination with medical therapy. The patient remained hemodynamically stable and without bleeding relapse. An esophagogastroduodenoscopy (EGD) was performed 1 month after the bleeding episode, which revealed large gastric varices (IGV 1) with red-whale signs. Prophylactic EBL was performed with two bands (Speedband Superview Super 7™ Multiple Band Ligators, Boston Scientific®). The patient remained without further bleeding and showed a progressive recovery of the hemoglobin values (Hgb 8.7 to 10.2 g/dL). One month later, the patient repeated the EGD, which showed obliteration of the enlarged varices and fibrotic deformation of the fundus.Motivation/justification for presentation: Elastic band ligation may be an effective tool for preventing rebleeding episodes in selected patients with gastric varices. These patients should be tightly monitored for rebleeding episodes.

Pesquisa

Ano

Título

Autores

Termos

Tipo de Comunicação