Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Abstract

Jejunal varices are a rare manifestation of portal hypertension, and they are associated with a high mortality and poor prognosis when bleeding occurs. A bleeding jejunal varix is much more challenging to diagnose and manage because of its anatomic location. Herein, we describe the case of a 62-year-old man with active jejunal variceal bleeding who presented with massive hematochezia and hypovolemic shock. He was treated successfully with a high volume and concentration of a glue mixture as endoscopic sclerotherapy using single-balloon enteroscopy in the intensive care unit. Enteroscopic sclerotherapy is an effective option for jejunal variceal bleeding.

Massive hematochezia due to jejunal varices successfully treated with coil embolization

“…Although their role has not yet been established in small intestine bleeding, somatostatin analogs have been used as a temporizing measure by several authors as well as ourselves. 10,14 To date, no evidence-based guidelines dealing with jejunal varices treatment have been published. Difficult to localize and reach with limited published data, management of small bowel varices remains challenging.…”

“…1 The main side effects of endoscopic local treatments are perforation and varices ulcers-related bleeding. 14 To sum up, jejunal variceal bleeding is a rare but lifethreatening entity. It should be considered in patients with PHT and obscure bleeding even in absence of surgical history.…”

“…When it comes to clinical management, the first step usually consists in resuscitation measures and correction of anemia. Although their role has not yet been established in small intestine bleeding, somatostatin analogs have been used as a temporizing measure by several authors as well as ourselves 10,14 . To date, no evidence‐based guidelines dealing with jejunal varices treatment have been published.…”

“…Yet, the endoscopic approach remains very valuable during the follow‐up to ensure variceal eradication and for the surveillance even when the initial bleeding episode is controlled with radiological interventions 1 . The main side effects of endoscopic local treatments are perforation and varices ulcers‐related bleeding 14 …”

Treatment of jejunal variceal bleeding with portal vein thrombosis after bile duct cancer surgery by short single‐balloon endoscope

“…Jejunal variceal bleeding is quite rare, and there are no reports that show the detailed method. [1][2][3][4][5] This is the first report using short singleballoon endoscope, IDUS, sandwich method of 5% glucose solution and the combination injection of 75% CA and 5% EO for jejunal varices bleeding.…”