EUS-assisted thrombin injection for ectopic bleeding varices--a case report and review of the literature

Krystallis, C.; McAvoy, Norma C.; Wilson, J. A.; Hayes, Peter; Plevris, John

doi:10.1093/qjmed/hcr030

Cited by 15 publications

(19 citation statements)

References 14 publications

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“…Other endovascular management options, including balloon-retrograde transvenous obliteration, have similar re-bleeding risk when compared with TIPS 8 9. For small bowel varices accessible by endoscopy (push enteroscopy, double-balloon enteroscopy and colonoscopy), other therapeutic interventions to achieve haemostasis have shown success including variceal banding,10 sclerotherapy and thrombin injection 11. In these cases, EUS may be helpful in the characterisation of lesions and assessment of sclerosant effect if sclerotherapy is used 12…”

Section: Discussionmentioning

confidence: 99%

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

et al. 2018

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A newly diagnosed 53-year-old woman with cirrhosis has repeated gastrointestinal bleeding with resulting symptomatic anaemia. She underwent routine diagnostic endoscopic evaluation without localisation of the aetiology of her bleed. Ultimately, she was found to have ectopic varices in the small bowel as a result of underlying high portal pressures. She underwent transjugular intrahepatic portosystemic shunt for portal system decompression with resolution in her bleeding.

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Section: Discussionmentioning

confidence: 99%

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

et al. 2018

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“…Currently it is advocated to start vasoactive medication and to try endoscopic measures if technically feasible, with band ligation for small varices only (due to the risk of a large mucosal defect) and cyanoacrylate injection being the most consensual 4 11–13. There are reports on alternative endoscopic techniques like human thrombin injection5 6 that may be less likely to cause thromboembolic complications 14. In case of treatment failure, options include interventional radiology either with TIPS placement or with other less studied modalities like BRTO, percutaneous transhepatic variceal embolisation (PTVE) or partial splenic embolisation 15 16.…”

Section: Discussionmentioning

confidence: 99%

“…Case reports and case series include medical treatment with vasoactive drugs, elastic band ligation, cyanoacrylate4 and human thrombin injection5 6 as endoscopic modalities, transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) by means of interventional radiology and, finally, performing a surgical shunt 3…”

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal bleeding in cirrhosis: varix or no varix?

Ferreira¹,

Sousa

Brito

et al. 2013

BMJ Case Reports

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SUMMARYUpper gastrointestinal bleeding from variceal origin is a frequent complication in the cirrhotic population. Duodenal variceal haemorrhage, however, is infrequent and the endoscopic management of such lesions is not straightforward. Non-endoscopic options include vasoactive drugs, transjugular intrahepatic portosystemic shunt (TIPS), transvenous obliteration and surgery as rescue therapy. We present a patient with Child-Pugh A hepatitis C virus-cirrhosis with acute bleeding from a duodenal varix. It was managed with elastic band ligation but late rebleeding occurred after 6 weeks. Gastroduodenoscopy revealed active bleeding from the ligation eschar. Band ligation and sclerosis were attempted but unsuccessful. Terlipressin was started and the patient referred for TIPS. Surprisingly, angiography showed a normal hepatic vein pressure gradient; therefore, TIPS was not performed. Haemorrhage ceased with medical treatment alone. The patient remained stable and was discharged after 10 days, being currently under evaluation for hepatitis C therapy. BACKGROUND

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“…Echoendoscope Radial- [Rana et al 2011;Krystallis et al 2012] or linear-array [Kinzel et al 2014;Ribeiro et al 2001;Gonzalez et al 2012;Romero-Castro et al 2007, 2013Lahoti et al 2000;Binmoeller et al 2011;Law et al 2014;Bhat et al 2015] therapeutic echoendoscopes with color Doppler have been used by most endoscopists for localizing and targeting the feeding vessels.…”

Section: Techniquementioning

confidence: 99%

Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique

Jain

Thosani

Singhal

2016

Therap Adv Gastroenterol

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Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis. While some are successfully managed by repeat endoscopic intervention, a few fail to respond or are not amenable to endoscopic hemostasis. As of now, the next level of intervention is passed on to either surgeons or interventional radiologists. There is new evidence suggesting the increased utility of endoscopic ultrasound (EUS) in diagnosis and treatment of culprit vascular lesions across the gut. In addition, EUS-assisted technique has also been used in the primary prevention of bleeding from gastroesophageal varices. In this review article, we have summarized case series and reports describing the use of EUS-assisted hemostasis. Indications, techniques, complications and success rates reported are discussed. While most of the authors describe their experience with primary and secondary treatment of gastric varices, treatment of other gastrointestinal lesions with EUS assisted hemostatic techniques is also discussed.

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EUS-assisted thrombin injection for ectopic bleeding varices--a case report and review of the literature

Cited by 15 publications

References 14 publications

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

Upper gastrointestinal bleeding in cirrhosis: varix or no varix?

Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique

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