Two cases of successful treatment of bleeding esophagojejunal varices after total gastrectomy using reopenable clip hemostasis.
Kengo Kasuga, Tatsuya Kouga, Megumi Shimizu et al.
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Case in brief
Two men with cirrhosis and prior total gastrectomy presented with upper gastrointestinal bleeding. Emergency endoscopy identified ruptured varices at the esophagojejunal anastomosis: on the jejunal side in one patient and the esophageal side in the other. Endoscopic variceal ligation was unsuccessful because severe fibrosis made treatment difficult. Reopenable through-the-scope clips achieved hemostasis in both cases. In the first case, subsequent injection sclerotherapy confirmed interruption of blood flow at the clip sites. Neither patient had rebleeding during the reported follow-up: 2 years and 4 months, respectively.
What made this case unusual
Severe fibrosis at the postoperative anastomosis prevented successful ligation, while reopenable clips controlled bleeding from varices on either the jejunal or esophageal side.
Diagnostic / clinical pearl
In bleeding esophagojejunal anastomotic varices after total gastrectomy, fibrosis may make EVL technically unsuccessful; reopenable clips achieved hemostasis in these two cases.
Why it matters
The report describes a potential endoscopic option for this rare, potentially life-threatening complication when EVL is difficult or unsuccessful.