Successful staged endoscopic treatment of multiple gastrointestinal varices caused by oxaliplatin-induced sinusoidal obstruction syndrome.
Naoya Kinsho, Tsunetaka Kato, Takuto Hikichi et al.
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Case in brief
A 71-year-old man developed non-cirrhotic portal hypertension after oxaliplatin-based adjuvant chemotherapy for rectal cancer. Imaging showed splenomegaly, portal collaterals, gallbladder wall thickening, and reduced portal venous flow, without evidence of cirrhosis or hepatic venous outflow obstruction. Endoscopy identified esophageal, duodenal, and gastric varices. Because portal hypertension persisted more than 3 years after oxaliplatin cessation, spontaneous regression was considered unlikely. Varices were treated in stages: esophageal injection sclerotherapy first, then n-butyl-2-cyanoacrylate injection for duodenal and gastric varices. High-risk varices were eradicated without adverse events, and no bleeding occurred during 6 months of follow-up.
What made this case unusual
Multiple varices across the esophagus, duodenum, and stomach developed in the setting of oxaliplatin-associated sinusoidal obstruction syndrome and non-cirrhotic portal hypertension, with portal hypertension persisting years after chemotherapy ended.
Diagnostic / clinical pearl
In a patient with prior oxaliplatin exposure and portal hypertension, varices may persist or develop despite cessation of chemotherapy and absence of cirrhosis; endoscopic assessment can identify varices at multiple gastrointestinal sites.
Why it matters
The case describes risk-based, staged endoscopic treatment of varices at different sites, with eradication and no adverse events or bleeding during the reported follow-up.