Percutaneous transhepatic obliteration for esophagojejunal varices after total gastrectomy

A 59-year-old man experienced hematemesis 5 years after a total gastrectomy and Roux-en-Y esophagojejunostomy for carcinoma of the cardia. Endoscopic examination revealed the esophagojejunal blue small varices with cherry-red spots. Percutaneous transhepatic portography showed that the varices were supplied by the vein of the ascending jejunal limb. The 3-French microcatheter was inserted into this vein through the 5-French catheter, and 0.5 mL of absolute ethanol and 2 mL of ethanolamine oleate with iopamidol were injected, which visualized the esophagojejunal varices and obliterated varices at the same time. There were no complications during the operation, and the subsequent clinical course showed no further bleeding. We conclude that percutaneous transhepatic obliteration with a 3-French microcatheter is one of the most effective means of treating esophagojejunal small varices arising after a total gastrectomy.