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Case Reports
. 2010:2010:518260.
doi: 10.1155/2010/518260. Epub 2010 Apr 29.

Successful endoscopic injection sclerotherapy of high-risk gastroesophageal varices in a cirrhotic patient with hemophilia A

Kohei Fukumoto  1 , Hideyuki Konishi, Koichi Soga, Ki-Ichiro Miyawaki, Hitoshi Okano, Masahito Minami, Naoki Wakabayashi, Shoji Mitsufuji, Norimasa Yoshida, Tomohisa Takagi, Nobuaki Yagi, Yuji Naito, Keisho Kataoka, Toshikazu Yoshikawa
Affiliations
Case Reports

Successful endoscopic injection sclerotherapy of high-risk gastroesophageal varices in a cirrhotic patient with hemophilia A

Kohei Fukumoto et al. Gastroenterol Res Pract. 2010.

Abstract

A 68-year-old man with hemophilia A and liver cirrhosis caused by hepatitis C virus was referred to our hospital to receive prophylactic endoscopic treatment for gastroesophageal varices (GOV). He had large, tense, and winding esophageal varices (EV) with cherry red spots extending down to lesser curve, predicting the likelihood of bleeding. Esophageal endoscopic injection sclerotherapy (EIS) was performed with a total 15 mL of 5% ethanolamine oleate with iopamidol (EOI). Radiographic imaging during EIS demonstrated that 5% EOI reached the afferent vein of the varices. He was administered sufficient factor VIII concentrate before and after EIS to prevent massive bleeding from the varices. Seven days after EIS, upper gastrointestinal endoscopy (UGIE) showed that the varices were eradicated almost completely. Eighteen months after EIS, the varices continued to diminish. We report a successful case of safe and effective EIS for GOV in a high-risk cirrhotic patient with hemophilia A.

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Figures

Figure 1
Figure 1
GOV before EIS. (a, b) UGIE showed large, tense, and winding EV with cherry red spots extending down to lesser curve.
Figure 2
Figure 2
EIS procedure. (a) EIS was performed by intravariceal injection of 15 mL of 5% EOI in total. (b) Radiographic imaging showed that 5% EOI reached the cardiac plexus and LGV.
Figure 3
Figure 3
GOV seven days after EIS. (a, b) UGIE showed that the varices were eradicated almost completely without cherry red spots. (c) EUS showed high echoic areas in the lumen of the varices, indicating that the varices were completely thrombosed after EIS.
Figure 4
Figure 4
GOV eighteen months after EIS. (a, b) Follow-up endoscopy showed that the varices continued to shrink.
See this image and copyright information in PMC

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References

    1. Goedert JJ, Eyster ME, Lederman MM, et al. End-stage liver disease in persons with hemophilia and transfusion-associated infections. Blood. 2002;100(5):1584–1589. - PubMed
    1. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343–1349. - PubMed
    1. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175–1189. - PubMed
    1. World Federation of Hemophilia. Guidelines for the Management of Hemophilia. 2005.
    1. Furie B, Limentani SA, Rosenfield CG. A practical guide to the evaluation and treatment of hemophilia. Blood. 1994;84(1):3–9. - PubMed

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