Gastric ischemia after epinephrine injection in a patient with liver cirrhosis

Figure 1 Upper gastrointestinal endoscopy. A: Mucosal elevated lesion with a central depression of the gastric antrum anterior wall. We took an endoscopic biopsy of the elevated lesion; B: Endoscopy revealed the oozing bleeding covered by a hemorrhagic clot in the distal antrum after the endoscopic biopsy. We tried the hemostasis by submucosal injection of a 1:10 000 solution of epinephrine; C: Mucosal dissection with extensive ulcerated; D: Necrotic areas from the distal to the proximal antrum. We did the conservative treatment with proton pump inhibitor, wide spectrum antibiotics and parenteral nutrition; E: Three days after the conservative treatment, a large extensive ulcer with fibrinous and hemorrhagic exudates surrounded by a clear elevated margin. The conservative care was continued; F: Two months later, the decreased size of the ulcer was surrounded by regenerative epithelia with a clear margin.