Gastric Varices
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.


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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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