Prémio de Imagem Endoscópica 2022

Behind an adherent clot

Inês Botto, Juliana Serrazina, João Lopes, Narcisa Fatela, Luis Carrilho Ribeiro, Rui Tato Marinho

Centro Hospitalar Universitário Lisboa Norte

54-year-old man with HCV/alcoholic cirrhosis (Child-Pugh A) underwent endoscopic variceal band ligation as part of secondary prophylaxis of esophageal variceal hemorrhage. Two weeks later, he presented to the emergency department with upper gastrointestinal bleeding. Esophagogastroduodenoscopy revealed large esophageal varices and a post-variceal banding ulcer with adherent clot. After clot removal, a spurting hemorrhage occurred, which was controlled with injection of cyanoacrylate. The patient had an initial unfavorable outcome with early re-bleeding, which was successfully managed by early Transjugular Intrahepatic Portosystemic Shunt (TIPS), 48 hours after emergency endoscopy. Delayed re-bleeding after endoscopic band ligation is associated with high mortality rate (28-52%).