Year 2023 / Volume 115 / Number 3
Letter
A full hemostatic repertoire in a complex cirrhotic patient

145-146

DOI: 10.17235/reed.2022.9039/2022

Maria Manuela Estevinho, Rolando Pinho, Edgar Afecto, João Correia, Teresa Freitas,

Abstract
A 55-year-old woman with cirrhosis was admitted for acute decompensation caused by portal vein thrombosis. Ten days later, the patient presented melena. Esophagogastroscopy revealed two gastric polyps, both with bleeding stigmata. One of the polyps was removed with a diathermic loop, after adrenalin injection, while in the other the "ligate and let go" technique was applied, after biopsy. A “metallic tulip-bundle” technique, combining through the scope and over-the-scope clips, was applied for hemostasis. This case underlines how the combination of various endoscopic techniques may be useful to manage upper gastrointestinal bleeding, especially in patients with important comorbidities.
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References
1. Galante A, De Gottardi A. Portal vein thrombosis: an overview of current treatment options. Acta Gastroenterol Belg. 2021 Apr-Jun;84(2):327-332. doi: 10.51821/84.2.327.
2. Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, Lester W, Nylander D, Thoufeeq M, Vanbiervliet G, Wilkinson JR, Van Hooft JE. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021 Sep;70(9):1611-1628. doi: 10.1136/gutjnl-2021-325184.
3. Ponte, A., Pinho, R., Vale, S., Fernandes, C., Ribeiro, I., Silva, J., & Carvalho, J. (2015). Resection of a large ileal lipoma exhibiting ball-valve prolapse into the cecum with a "grasp-to-retract, ligate, unroof, and let-go" technique. Endoscopy, 47 Suppl 1 UCTN, E215–E216. https://doi.org/10.1055/s-0034-1391824
4. Gomes C, Pinho R, Afecto E, Correia J, Estevinho M, Carvalho J. "Metallic tulip bundle" technique as rescue hemostatic therapy after endoscopic mucosal resection of a gastric lesion. Indian J Gastroenterol. 2022 Jan 4. doi: 10.1007/s12664-021-01203-6.
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Estevinho M, Pinho R, Afecto E, Correia J, Freitas T. A full hemostatic repertoire in a complex cirrhotic patient. 9039/2022


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Publication history

Received: 28/06/2022

Accepted: 28/06/2022

Online First: 06/07/2022

Published: 07/03/2023

Article Online First time: 8 days

Article editing time: 252 days


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