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

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

SUBMITTER: Qatomah A 

PROVIDER: S-EPMC11825136 | biostudies-literature | 2025 Jan-Dec

REPOSITORIES: biostudies-literature