title: Bleeding from a duodenal varix: a unique case of variceal hemostasis achieved using EUS-guided placement of an embolization coil and cyanoacrylate.
abstract: We report a case of a bleeding duodenal varix demonstrating excellent hemostasis achieved by endoscopic ultrasound (EUS)-directed placement of an embolization coil followed by cyanoacrylate. A 31-year-old man with decompensated Child's class C cirrhosis presented with hematemesis. An initial endoscopy revealed an actively bleeding duodenal varix. Subsequent attempt at hemostasis with ethanolamine oleate injection failed. A later attempt at hemostasis involving EUS-guided placement of an embolization coil followed by cyanoacrylate injection into the varix was successful. We reviewed the literature involving the treatment of bleeding ectopic varices and conclude that EUS provides a unique and advantageous modality for achieving variceal hemostasis of duodenal varices in patients who are not candidates for transjugular intrahepatic portosystemic shunt.
authors: Yale University School of Medicine-Yale New Haven Hospital, New Haven, CT.
authors: Jason
authors: J
authors: Kinzel
authors: Nipaporn
authors: N
authors: Pichetshote
authors: Serag
authors: S
authors: Dredar
authors: Harry
authors: H
authors: Aslanian
authors: Anil
authors: A
authors: Nagar
mesh_terms: D000328:Adult; D003487:Cyanoacrylates / Q000008:administration & dosage; D004386:Duodenum / Q000473:pathology; D004621:Embolization, Therapeutic / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D007267:Injections; D008297:Male
chemical_list: D003487:Cyanoacrylates