Related Experiment Video
Updated: Aug 15, 2026
02:14
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Bleeding gastric varices and antiphospholipid syndrome
Daniel R Gaya1, Karin A Oien, Adrian J Stanley
1Department of Gastroenterology, Glasgow Royal Infirmary, UK. danielgaya@aol.com
Nature Clinical Practice. Gastroenterology & Hepatology
|November 3, 2005
Summary
A patient with antiphospholipid syndrome developed gastric varices due to nodular regenerative hyperplasia. Treatment involved endoscopic glue injection and a transjugular intrahepatic portosystemic shunt.
Area of Science:
- Hepatology
- Gastroenterology
- Vascular Medicine
Background:
- A 35-year-old woman with antiphospholipid syndrome and a history of thrombosis presented with obscure gastrointestinal bleeding.
- She was on long-term oral anticoagulation therapy, with initial investigations revealing isolated gastric varices.
Observation:
- The patient had no prior history of liver disease or known risk factors for portal hypertension.
- Investigations included CT venography, endoscopic ultrasound, and transjugular liver biopsy to determine the cause of the varices.
Findings:
- Diagnosis of nodular regenerative hyperplasia (NRH) of the liver was established.
- NRH was identified as the underlying cause of the gastric varices in this patient.
Implications:
- This case highlights NRH as a potential cause of gastric varices, even without typical signs of liver disease.
- Successful management involved a combination of endoscopic histacryl tissue-glue injection and transjugular intrahepatic portosystemic shunt (TIPS).
- Long-term oral anticoagulation was continued post-procedure, emphasizing the need for careful management in patients with thrombotic conditions.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:24Esophageal Varices-I: Introduction
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
01:24Disorders of Hemostasis
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:22Portal Hypertension
Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...