Esophageal Stenting as Bridge Therapy to Direct Intrahepatic Portocaval Shunt for Refractory Variceal Bleeding

Abstract

V ariceal bleeding (VB) is the most severe complication of portal hypertension in patients with cirrhosis. Management of refractory VB is a challenging but commonplace scenario, in which usual endoscopic therapies, including variceal ligation and/or sclerotherapy, are unsuccessful in controlling the bleed. Portosystemic shunt (PSS) creation is one effective treatment in prevention of treatment failure and rebleeding. We present a case of refractory esophageal varices (EV) in which an esophageal stent was placed as a temporizing measure to stop bleeding before creation of an alternative PSS. Case PresentationA 54-year-old patient with decompensated biliary cirrhosis (Child-Pugh B) and extensive portal vein thrombus on anticoagulation presented with refractory esophageal VB, with recent discharge from the hospital 48 hours previous. The EV were refractory to banding and sclerotherapy attributed to significant scarring. As a temporizing measure, a fully covered self-expanding 18-mm-diameter ×120-mm-length metal esophageal stent (WallFlex; Boston Scientific, Marlborough, MA