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Emergency endoscopic ligation of actively bleeding gastric varices with a detachable snare
L Cipolletta1, M A Bianco, G Rotondano
1Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale A. Maresca, Torre del Greco, Italy.
Background:
Bleeding gastric varices (BGV) is a challenging condition whose management remains controversial and often empirical.
Methods:
Over the past 6 months, emergency ligation of BGV was performed in seven cirrhotic patients (five men, two women; age range 47 to 70 years) using a detachable snare. Child's grade was B in two and C in five patients. Two patients had a concurrent hepatocellular carcinoma. Three patients had been previously treated with either balloon tamponade or injection sclerotherapy for bleeding esophageal varices.
Results:
Hemostasis was achieved in all patients. Morbidity consisted of fever in one case. Six snares passed spontaneously, one was removed from the stomach on follow-up examination. Post-ligation ulcers were detected in all patients after treatment (mean diameter 7.4+/-2.1 mm) with no stigmata of recurrent hemorrhage. No early rebleeding was observed during hospital stay. On a mean follow-up of 3.8 months (range 2 to 6 months), no digestive hemorrhage was recorded. Ligated gastric varices were significantly 'reduced in size in four patients.
Conclusions:
Emergency ligation with detachable snare is feasible and may be an alternative life-saving method of endoscopic hemostasis in BGV.