Endoscopic Band Ligation of Bleeding Duodenal Varices

Ectopic variceal bleeding is an uncommon cause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and resource availability as treatment guidelines are lacking due to the infrequent occurrence of bleeding ectopic varices. We present a case of a middle-aged woman who presented with melena and anemia requiring transfusion. She was diagnosed with cirrhosis, and computed tomography of the abdomen revealed active bleeding at the proximal duodenum. She underwent emergent esophagogastroduodenoscopy, which showed actively bleeding duodenal varices secondary to portosystemic shunt from portal hypertension. Endoscopic hemostasis was achieved with variceal band ligation, a useful modality when alternative methods of emergent variceal management are unavailable. Given the risk of recurrent bleeding, the patient underwent embolization of varices by interventional radiology.