Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension: A case report

Figure 1 Gastroscopic image. Gastroscopy revealed gastric variceal with signs of recent bleeding in the absence of active bleeding.

Figure 2 Abdominal computed tomography venography image. Computed tomography venography revealed stenosis of the proximal superior mesenteric vein (red arrow), invisible proximal splenic vein, and increased collateral circulations (yellow arrows).

Figure 3 Endoscopic ultrasound images. A: Endoscopic ultrasound revealed an enlarged portal vein; B: A confluence of gastric varices was identified and selected as the injection site (red arrow); C: Undiluted N-butyl-2-cyanoacrylate (red arrow) was injected into the selected gastric varix via a 22-gauge needle; D: Hyperechoic fillings (red arrow) and decreased blood flow signals were observed after injections.

Figure 4 Gastroscopic image. With the help of biopsy forceps, the follow-up gastroscopy revealed firm gastric submucosa and no sign of N-butyl-2-cyanoacrylate expulsion.

Figure 5 Computed tomography venography image. Compared with the results before the operation (Figure 2), follow-up computed tomography venography revealed improvements in left-sided portal hypertension and collateral circulations (red arrows).