Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6254
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 hyper
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.
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.