Endoscopic Injection Sclerotherapy with Ethanolamine Oleate with Iopamidol for Esophagojejunal Varices in Idiopathic Portal Hypertension

Soga, Koichi; Tomikashi, Koichi; Miyawaki, Kohta; Okuda, K; Sugiyama, Yusuke; Sekikawa, Shuji; Wakabayashi, Naoki; Konishi, Hideyuki; Mitsufuji, Shoji; Kataoka, Keisuke; Yoshikawa, Toshikazu

doi:10.1007/s10620-008-0505-6

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…b Hemostasis was insufficient due to mucosal laceration through azygos [5]. Similar to our case, contrastenhanced CT examination revealed that the dilated jejunal vein was configured as esophagojejunal varices [6]. Boku and colleagues suggested two mechanisms for these varices formations.…”

Section: Discussionsupporting

confidence: 69%

A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction

et al. 2020

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Background: The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration. Case presentation: A 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days. Conclusion: PTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites.

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Section: Discussionsupporting

confidence: 69%

A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction

et al. 2020

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Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

Hsu¹,

Tsang²,

Teng³

et al. 2015

WJG

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Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.

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Endoscopic Injection Sclerotherapy with Ethanolamine Oleate with Iopamidol for Esophagojejunal Varices in Idiopathic Portal Hypertension

Cited by 2 publications

References 17 publications

A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction

A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction

Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

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