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Updated: Jan 2, 2026

Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Treating Untreatable Rectal Varices
Mónica Garrido1, Belarmino Gonçalves2, Sofia Ferreira3
1Department of Gastroenterology, Porto University Hospital Centre, Porto, Portugal.
Background:
Rectal varices are portosystemic collaterals that arise as a complication of portal hypertension. Despite their significant prevalence among cirrhotic patients, clinically important bleeding occurs only in a minority. Various treatment options are available, with endoscopic therapies being widely used, and both interventional radiology and surgery being considered for refractory bleeding rectal varices.
Case:
We report the case of a 61-year-old male with hepatic cirrhosis and bleedingrectal varices refractory to endoscopic therapy, successfully managed with a combination of transjugular intrahepatic portosystemic shunt (TIPS) and selective variceal embolization.
Conclusions:
Radiological techniques are effective options for refractory bleeding. Adding embolization to TIPS implantation could represent a valid adjunctive measure for haemostasis of recurrent rectal variceal bleeding.
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