Clip-Assisted Cyanoacrylate Injection for the Management of a Proximal Colonic Varix

Area of Science:

• Gastroenterology
• Vascular Surgery
• Interventional Endoscopy

Background:

• Colonic varices are a rare cause of lower gastrointestinal bleeding, often linked to portal hypertension.
• Extrahepatic portal vein obstruction (EHPVO) can lead to complex venous collaterals and variceal formation in the colon.

Purpose of the Study:

• To report a case of bleeding hepatic flexure varices in a patient with EHPVO.
• To demonstrate the efficacy of a novel endoscopic treatment for this rare condition.

Main Methods:

• A 23-year-old male with EHPVO and prior splenectomy presented with recurrent hematochezia.
• Diagnostic colonoscopy identified hepatic flexure varices with recent hemorrhage.
• Contrast-enhanced CT revealed portal vein abnormalities and mesenteric collaterals.
• Endoscopic therapy involved clip-assisted flow modulation and N-butyl-2-cyanoacrylate injection.

Main Results:

• Successful endoscopic obliteration of hepatic flexure varices was achieved.
• The patient experienced no further bleeding episodes post-procedure.
• The treatment demonstrated no immediate complications.

Conclusions:

• Hepatic flexure varices represent a rare but significant cause of lower gastrointestinal bleeding in EHPVO.
• Clip-assisted cyanoacrylate injection is a feasible and effective endoscopic strategy for managing high-flow colonic varices.