Gastric Varices
Gastric Varices

Video Endoscopic Sequence 1 of 11.

Endoscopy of acute bleeding due to gastric varix

A 69-year-old female, diabetic, presents her second hemorrhage due to gastro-esophageal varices. She had bleeded two years ago in another clinic banding of the esophagus was performed. The patient arrived to our unit with active bleeding and signs of hypovolemic shock.

Through the first endoscopy it is determined that the cause of the bleeding was gastric varices of the gastric fundus. She was immediately hospitalized and got stabilized with multiple transfusions. Later we proceeded to perform therapeutic endoscopy under endotracheal intubation.

In this image and video clip. varices of the esophagus and signs of active bleeding of the gastric fundus are observed.


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Gastric Varices

Video Endoscopic Sequence 2 of 11.

In the first endoscopy performed on an outpatient basis it is determined that the hemorrhage is due to gastric varices

In the gastric chamber is observed with abundant light red blood material as well as a thick layer of clots and bright red blood.

In people with portal hypertension, gastric varices are less prevalent than oesophageal varices. The risk of bleeding from gastric varices seems to be lower than from oesophageal varices; however, when gastric varices bleed, it is often severe and associated with higher mortality. Endoscopic sclerotherapy of bleeding gastric varices with N-butyl-2-cyanoacrylate glue (cyanoacrylate) is considered the best haemostasis with a lower risk of re-bleeding compared with other endoscopic methods. However, there are some inconsistencies between trials regarding mortality, incidence of re-bleeding, and adverse effects.

Gastric Varices

Video Endoscopic Sequence 3 of 11.

The second endoscopy with endotracheal intubation preventing bronchoaspiration.

A therapeutic endoscope is used in orther to look for the exact site of bleeding, esophageal varices are visualized, some engorged with the red sign, but none with active bleeding.

There is abundant bleeding as well as a thick layer of blood clots

 


Gastric Varices

Video Endoscopic Sequence 4 of 11.

With multiple maneuvers and patience, as well as aspiration of blood content, the gastric cardia is displayed.




Gastric Varices

Video Endoscopic Sequence 5 of 11.

The exact site of bleeding is found an ulcerated gastric varix of the fundus

 



Gastric Varices

Video Endoscopic Sequence 6 of 11.

Thick layer of clots

There are many clots which cause poor visualization of the fund, being this one responsible for one of the factors that the treatment of gastric varices is difficult.

 





Gastric Varices

Video Endoscopic Sequence 7 of 11.

After struggling in a somewhat prolonged period in search of the exact site of the hemorrhage, this ulcerated varice is observed being the exact site of the bleeding.

Gastric Varices

Video Endoscopic Sequence 8 of 11.

Pure histoacry infiltration is performed

1.5 cc of pure histoacryl is infiltrated. The hemorrhage stops, the patient evolves quite well, stabilizing her vital signs.

Gastric Varices

Video Endoscopic Sequence 9 of 11.

Final state of pure histocril infiltration.

The vital signs were stabilized and red blood was not observed. The bleeding was stopped successfully.



Gastric Varices

Video Endoscopic Sequence 10 of 11.

After the infiltration of pure histocril, the vital signs were stabilized and an endoscopic inspection was always carried out, as well as aspirating the abundant blood remains, and no red blood was seen.

 


Gastric Varices

Video Endoscopic Sequence 11 of 11.

The important thing about treating acute bleeding with endotracheal intubation which prevents bronchospiration

The patient evolved very well leaving the hospital two days later.

 


gastric varices

Video Endoscopic Sequence 1 of 12.

Endoscopy of Gastrointestinal Hemorrhage due to a gastric varix.

This is a 62 year-old male, diabetic presents its second hemorrhage due to a gastric varix.

Half an hour earlier, the patient had an episode of hematemesis, is a bricklayer who carried out works in the same building where our endoscopic unit and was handled emergency

In this image and video clip shows some esophageal varices. Also in the stomach there are dark red blood.

Hemorrhage was detected due to a gastric varix approximately two centimeters below the gastroesophageal junction and rear wall. therapy was used with infiltration of dermabond, stopping the bleeding successfully.


 

varice gástrica

Video Endoscopic Sequence 2 of 12.

Looking for the exact site of bleeding

In the stomach is observed with abundant material of dark blood after the gastroesophageal junction there is a varix with white dot.

 



varice gástrica sangrado

Video Endoscopic Sequence 3 of 12.

The exact site of the bleeding is identified

It is observed through the gastroesophageal junction the exact site of bleeding, varix with a white dot (fibrin).

 


varice gástrica hemorragia

Video Endoscopic Sequence 4 of 12.

Cardio-Fundal Gastric Varices

Two varices one with an ulcer (exact site of bleeding) are shows.

 




varice gástrica pegamento

Video Endoscopic Sequence 5 of 12.

Endoscopic Therapy for Gastric Varices

Infiltration with Dermabond

2.5 cc of dermabond is prepared which infiltrates para-variceal over a period of 45 seconds.

várices gástricas

Video Endoscopic Sequence 6 of 12.

Following infiltration dermabond, there is heavy bleeding at the site where infiltration was performed, It used Hemostatic therapy with argon plasma coagulator.

Gastric variceal bleeding is an uncommon, serious complication of portal hypertension. The significant morbidity and mortality resulting from bleeding from gastric varices presents a challenge for gastroenterologists. The management of this complication has not been standardized. Although transjugular intrahepatic portosystemic shunt (TIPS) is used in many centres to treat gastric varices, endoscopic treatment with the tissue glue cyanoacrylate (N-butyl-2-cyanoacrylate) has been used successfully in many countries for 20 years and is considered, by many clinicians, to be the optimal initial treatment for bleeding gastric varices. Despite the widespread use of cyanoacrylate, there are still controversies in the literature regarding its use. The present article deals with the indications, technique, preparation, catheter use, long-term results and cost-effectiveness of the procedure. Close attention to these recommendations can result in successful and safe usage of the tissue glue.



varice gástrica argon plasma

Video Endoscopic Sequence 7 of 12.

Argon Plasma (APC). Superficially and carefully touches of argon plasma coagulator, stopping successfully the second bleeding.

varice gástrica

Video Endoscopic Sequence 8 of 12.

Image and video clip post-bleeding.

Bleeding stops, the patient develops quite well the respective transfusions are performed and was discharged after two days.

The argon plasma coagulator is very effective for therefore bleeding esophageal and gastric varices. But it must be used carefully.


varice gástrica

Video Endoscopic Sequence 9 of 12.

End of intervention with APC and infiltration of dermabond state.



varice gástrica

Video Endoscopic Sequence 10 of 12.

Follow-up endoscopy 14 days later

A new endoscopy is performed, observing the state of endoscopic therapy. Neither cardio-fundal gastric varices were found, which were responsible for bleeding.

 


varice gástrica

Video Endoscopic Sequence 11 of 12.

Gastric Fundus

In the second endoscopy, thanks to the infiltration of glue, no cardio-fundal gastric varices are observed, which were apparently disappeared, were below the gastroesophageal junction.

 


Gastric Varix

Video Endoscopic Sequence 12 of 12.

The second endoscopy which is performed to ligate several esophageal varices.

 

 

 

 

Gastric Varix

Video Endoscopic Sequence 1 of 2.

Gastric Varices

In this endoscopic sequence, is compared between an endoscopy with gastric varices and seven years later, duringin the period there was no bleeding.

 

 

 

 

 

 

Gastric Varices

Video Endoscopic Sequence 2 of 2.

Seven years after a follow up endoscopy was performed

Gastric varices grew in size and there is also a portal hypertensive gastropathy.


 

 



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