Endoscopic titanium clip with nylon loop for treating esophageal and gastric variceal bleeding after endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt
Xubiao Nie, Yawen Li, Yongjun Liu, Changjiang Hu, Chaoqiang Fan
Abstract
Genes, proteins, chemicals, diseases, species, mutations and cell lines named across the full text — each resolved to its canonical identifier and authoritative record.
- —Chongqing Health Appropriate Technology Promotion Project
- —Second Affiliated Hospital of the Army Military Medical University Incubation program project of Young Doctoral Talents
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TopicsLiver Disease and Transplantation · Organ Transplantation Techniques and Outcomes · Liver Disease Diagnosis and Treatment
A 49-year-old man experienced intermittent hematemesis and melena for over a decade. He was diagnosed with decompensated liver cirrhosis secondary to chronic hepatitis B more than 10 years ago and has since been managed conservatively with pharmacotherapy. He presented to a local hospital 8 days ago with recurrence of hematemesis and underwent endoscopic variceal ligation (EVL). Following stabilization, he was transferred to our department for a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
On postoperative Day 3, the patient developed recurrent hematemesis. After fluid resuscitation and blood transfusion, an urgent gastroscopy revealed esophageal and gastric varices combined with multiple ulcers, including an ulcer of about 1 cm in diameter located on a varicose vein at the cardia with active bleeding. Re-ligation was not feasible. Therefore, we utilized titanium clips with nylon loop to suture the ulcer surface, successfully controlling the hemorrhage ( Video 1 ).
The patient’s condition improved following postoperative management, including continued fluid resuscitation and measures to reduce portal pressure, and he was subsequently discharged.
Although EVL is regarded as one of the most effective treatment modalities for esophageal varices, post-EVL bleeding remains a significant clinical challenge 1 . TIPS has been shown to be more efficacious in reducing rebleeding and rebleeding-related mortality rates in patients with cirrhotic esophageal varices 2 . Despite subsequent TIPS intervention, this patient experienced recurrent bleeding. Consequently, for patients who exhibit early bleeding following EVL combined with TIPS, the application of titanium clips with nylon loop can serve as an effective and timely remedial measure for achieving emergency hemostasis.
Endoscopy_UCTN_Code_TTT_1AO_2AD
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1European Association for the Study of the Liver EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis J Hepatol 20186940646029653741 10.1016/j.jhep.2018.03.024 · doi ↗ · pubmed ↗
- 2Jing L Zhang Q Chang Z Nonsurgical secondary prophylaxis of esophageal variceal bleeding in cirrhotic patients: a systematic review and network meta-analysis J Clin Gastroenterol 20215515916810.1097/MCG.000000000000143633122601 · doi ↗ · pubmed ↗