Successful endoscopic injection sclerotherapy of high-risk gastroesophageal varices in a cirrhotic patient with hemophilia A.
A 68-year-old man with hemophilia A and liver cirrhosis caused by hepatitis C virus was referred to our hospital to receive prophylactic endoscopic treatment for gastroesophageal varices (GOV). He had large, tense, and winding esophageal varices (EV) with cherry red spots extending down to lesser curve, predicting the likelihood of bleeding. Esophageal endoscopic injection sclerotherapy (EIS) was performed with a total 15 mL of 5% ethanolamine oleate with iopamidol (EOI). Radiographic imaging during EIS demonstrated that 5% EOI reached the afferent vein of the varices. He was administered sufficient factor VIII concentrate before and after EIS to prevent massive bleeding from the varices. Seven days after EIS, upper gastrointestinal endoscopy (UGIE) showed that the varices were eradicated almost completely. Eighteen months after EIS, the varices continued to diminish. We report a successful case of safe and effective EIS for GOV in a high-risk cirrhotic patient with hemophilia A.
Fukumoto
Kohei
K
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Konishi
Hideyuki
H
Soga
Koichi
K
Miyawaki
Ki-Ichiro
K
Okano
Hitoshi
H
Minami
Masahito
M
Wakabayashi
Naoki
N
Mitsufuji
Shoji
S
Yoshida
Norimasa
N
Takagi
Tomohisa
T
Yagi
Nobuaki
N
Naito
Yuji
Y
Kataoka
Keisho
K
Yoshikawa
Toshikazu
T
Am J Gastroenterol. 1988 Nov;83(11):1240-4
3263792
Endoscopy. 1994 Nov;26(9):734-40
7712967
Gastroenterology. 2004 Apr;126(4):1175-89
15057756
Blood. 1994 Jul 1;84(1):3-9
8018925
Indian J Gastroenterol. 1998 Jan;17(1):10-2
9465505
J Gastroenterol Hepatol. 1999 Mar;14(3):236-40
10197492
Endoscopy. 1993 May;25(4):287-9
8330548
Hepatology. 1988 Nov-Dec;8(6):1495-500
3056821
Blood. 2002 Sep 1;100(5):1584-9
12176875
J Gastroenterol Hepatol. 1999 Mar;14(3):241-4
10197493
Gastrointest Endosc. 1993 Mar-Apr;39(2):123-6
8495830
Hepatology. 1992 Dec;16(6):1343-9
1446890
Eur J Gastroenterol Hepatol. 1998 Feb;10(2):151-3
9581992
Endoscopy. 1994 Nov;26(9):729-33
7712966