Pipeline Esophagogastric Varices Secondary to Extrahepatic Portal Vein Obstruction Treated Endoscopically with the Assistance of Transileocolic Obliteration

Abstract

Endoscopic injection sclerotherapy (EIS) for esophagogastric varices (EGV) was attempted for a 29-yearold man with extrahepatic portal vein obstruction. However, pipeline varices characterized by a large blood flow volume were present, and the sclerosant did not accumulate sufficiently in them. Transileocolic obliteration (TIO) using coils was performed, but some EGVs and palisading veins remained. Thus, EIS was performed once again immediately after TIO. Since a reduction in the intravariceal blood flow was achieved by preceding TIO, effective injection of sclerosant into the vessels was possible. For pipeline varices difficult to treat endoscopically, combination therapy with TIO may be effective.

Emergency transileocolic vein obliteration for life-threatening bleeding from gastric varices

“…We reported a case of life-threatening bleeding from gastric varices in a patient with alcoholic cirrhosis that was managed by emergency TIO [9] , [10] , [11] , [12] . There were 3 important issues: (1) Is there an indication for prophylactic treatment for large gastric varices with portal vein stenosis?…”

“…TIO is more invasive than PTO, but it should be selected in patients with portal vein stenosis or ascites. There are few reports of TIO [9] , [10] , [11] , [12] , 21] . Yokoyama et al.…”

“…Yokoyama et al. [9] have summarized 15 reported cases of TIO from 1992 to 2022. In his report, the locations of varices were 1 case of esophageal varices, 3 cases of esophagogastric varices, 4 cases of gastric varices, 2 cases of duodenal varices, 1 rectal varix, 1 bile duct varices, 1 jejunal varices, and 2 anastomotic varices after abdominal surgery.…”

“…We report a case of life-threatening bleeding from gastric varices who has alcoholic cirrhosis. He was managed successfully by an emergency transileocolic vein obliteration (TIO) [9] , [10] , [11] , [12] .…”