Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case
Introduction: Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination with antimicrobial therapy prior to endoscopic variceal ligation. In cases of refractory EVB, trans-jugular intrahepatic po...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2025-02-01
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| Series: | Case Reports in Gastroenterology |
| Online Access: | https://karger.com/article/doi/10.1159/000543537 |
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| Summary: | Introduction: Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination with antimicrobial therapy prior to endoscopic variceal ligation. In cases of refractory EVB, trans-jugular intrahepatic portosystemic shunt (TIPSS) is recommended; however, it is contraindicated in up to 35% of cases. Case Presentation: We report a case of a 61-year-old male newly diagnosed with hepatocellular carcinoma and extensive portal vein thrombosis. The patient developed a refractory EVB failing medical and endoscopic therapies which was successfully treated with transcutaneous left gastric vein embolization (LGVE). Conclusion: LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise. |
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| ISSN: | 1662-0631 |