title: Multimodal therapy of recurrent and refractory bleeding from esophageal varices - case report and review of the literature.
abstract: Bleeding from esophageal varices is a major cause of mortality in patients with advanced liver disease. Although standard treatment and secondary prophylaxis are effective, in some patients sustained hemostasis cannot be achieved. We report the case of a woman with alcoholic liver disease in whom pharmacological, endoscopic, and intravascular therapies failed to control variceal bleeding. Only a combination of (repeated) band ligation, insertion of a self-expanding metal stent, TIPS implantation and redilatation, transjugular variceal embolization, and finally implantation of a portocaval shunt proved to be successful. We discuss the stepwise approach to this situation and the challenges encountered in the process.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Buechter
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Penndorf
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Canbay
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Theysohn
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dechêne
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000379:methods; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation / Q000379:methods*; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods