Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6254-6260
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6254
Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension: A case report
Jian Yang, Yan Zeng, Jun-Wen Zhang
Jian Yang, Jun-Wen Zhang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Yan Zeng, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Author contributions: Yang J, Zeng Y and Zhang JW designed the research study; Yang J and Zhang JW performed the endoscopic procedures; Yang J and Zeng Y performed the literature search, analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jun-Wen Zhang, MD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
Received: December 12, 2021
Peer-review started: December 12, 2021
First decision: February 8, 2022
Revised: February 9, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: June 26, 2022

Left-sided portal hypertension (LSPH), also known as sinistral portal hypertension or regional portal hypertension, refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis. N-butyl-2-cyanoacrylate (NBC) has been widely used in the endoscopic hemostasis of portal hypertension, but adverse events including renal or pulmonary thromboembolism, mucosal necrosis and gastrointestinal (GI) bleeding may occur after treatment. Herein, we report successfully managing gastric variceal (GV) hemorrhage secondary to LSPH using modified endoscopic ultrasound (EUS)-guided selective NBC injections.


A 35-year-old man was referred to our hospital due to an upper GI hemorrhage. Gastroscopy revealed GV hemorrhage and computed tomography venography (CTV) confirmed LSPH. The patient requested endoscopic procedures and rejected surgical therapies including splenectomy. EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose. The “sandwich” method using undiluted NBC and hypertonic glucose was applied. No complications occurred. The patient was followed up regularly after discharge. Three months later, the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH. No recurrent GI hemorrhage was reported during this follow-up period.


EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.

Keywords: Left-sided portal hypertension, Endoscopic ultrasound, Selective, N-butyl-2-cyanoacrylate, Gastric varices, Case report

Core Tip: Gastric variceal (GV) hemorrhage caused by left-sided portal hypertension (LSPH) is a severe complication. Endoscopic ultrasound (EUS)-guided procedures for GV hemorrhage demonstrated beneficial results in reducing complication risks. Herein, we report the successful management of GV hemorrhage secondary to LSPH using EUS-guided selective N-butyl-2-cyanoacrylate injection which proved the effectiveness and safety of this method. This case is the first report choosing confluences of gastric varices as injection sites to reduce the injection dose and postoperative complications in patients with LSPH.