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. 2025 Feb 13;19(1):67-71.
doi: 10.1159/000543537. eCollection 2025 Jan-Dec.

Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case

Abdulrahman Qatomah  1   2 , Ali Bessissow  3 , Yen-I Chen  1 , Talat Bessissow  1 , Amine Benmassaoud  1
Affiliations

Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case

Abdulrahman Qatomah et al. Case Rep Gastroenterol. .

Abstract

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.

Keywords: Embolization; Gastric vein; TIPSS; Variceal bleeding.

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Conflict of interest statement

Ali Bessissow and Yen-I Chen are consultants for Boston Scientific and are the co-founders of ChessMedical. Other authors have no conflict of interest.

Figures

Fig. 1.
Fig. 1.
a Endoscopic band ligation. b CT scan showing large HCC (blue arrow) and tumor thrombus of the portal vein (black arrow). c, d Pre- and post-embolization of left gastric vein with complete obliteration.
See this image and copyright information in PMC

References

    1. Raţiu I, Lupuşoru R, Popescu A, Sporea I, Goldiş A, Dănilă M, et al. . Acute gastrointestinal bleeding: a comparison between variceal and nonvariceal gastrointestinal bleeding. Medicine. 2022. 101(45):e31543. - PMC - PubMed
    1. Xu L, Ji F, Xu QW, Zhang MQ. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation. World J Gastroenterol. 2011;17(28):3347–52. - PMC - PubMed
    1. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty . Baveno VII: renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–74. - PMC - PubMed
    1. Kaplan DE, Ripoll C, Thiele M, Fortune BE, Simonetto DA, Garcia-Tsao G, et al. . AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2023;79(5):1180–211. - PubMed
    1. García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. . Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370–9. - PubMed

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