Abdulrahman Qatomah, Ali Bessissow, Yen-I Chen, Talat Bessissow, Amine Benmassaoud
{"title":"Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case.","authors":"Abdulrahman Qatomah, Ali Bessissow, Yen-I Chen, Talat Bessissow, Amine Benmassaoud","doi":"10.1159/000543537","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Case presentation: </strong>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).</p><p><strong>Conclusion: </strong>LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"67-71"},"PeriodicalIF":0.5000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825136/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000543537","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
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.
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