Successful treatment using a side-viewing duodenoscope for esophagojejunal varices on the jejunal side of the anastomosis site after total gastrectomy

Maruyama, Hirotsugu; Higashimori, Akira; Maeda, Natsumi; Ominami, Masaki; Fukunaga, Shusei; Nagami, Yasuaki; Fujiwara, Yasuhiro

doi:10.1055/a-1625-5369

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“…Ectopic varices after surgical reconstruction are supplied and drained via a special route. In cases with a history of proximal or total gastrectomy, esophagojejunal varices infrequently develop because the feeding veins, such as the left gastric vein, posterior gastric vein, or short gastric vein, are all resected in operation [4][5][6][7][8]. An increase in the venous outflow in the anastomotic region after total gastrectomy and esophagojejunostomy and neovascularization due to adhesion and inflammation in the peritoneal cavity cause variceal formation [4].…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, intraperitoneal tissue adhesion and intricate anatomical reconstruction make reoperation difficult. Several case reports have described the successful treatment of esophagojejunal varices using an endoscopic approach, PTO, or PTO combined with transjugular intrahepatic portosystemic shunt (TIPS) [4][5][6][7][8]. Initially, we also attempted the PTO technique, and we later combined a transfemoral retrograde approach.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Esophagojejunal Variceal Rupture after Total Gastrectomy and Esophagojejunostomy Successfully Treated with Percutaneous Transhepatic Obliteration under Dual-balloon Occlusion of Feeding and Draining Veins

Kawai

Yata

Matsumoto

et al. 2022

Interventional Radiology

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We present the case of a man in his 60s with bleeding esophagojejunal varices occurring after gastrectomy for gastric carcinoma. Percutaneous transhepatic portography depicted the esophagojejunal varices originated from the jejunal vein and drained into the azygos vein. A 5-French occlusion balloon catheter was wedged into the jejunal vein and a 3-French occlusion balloon catheter into one drainage channel of the esophagojejunal varices via the azygos vein. Selective antegrade jejunal venography under dual-balloon occlusion revealed entire esophagojejunal varices with good stagnated and well-opacified contrast medium. Subsequently, 12 mL of 5% ethanolamine oleate-contrast medium mixture was slowly injected into the esophagojejunal varices. He was discharged without complications one week after the procedure, and abdominal computed tomography demonstrated the disappearance of the esophagojejunal varices six months after the procedure.

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