Yang GC, Mo YX, Zhang WH, Zhou LB, Huang XM, Cao LM. Endoscopic clipping for the secondary prophylaxis of bleeding gastric varices in a patient with cirrhosis: A case report. World J Clin Cases 2022; 10(4): 1447-1453 [PMID: 35211582 DOI: 10.12998/wjcc.v10.i4.1447]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Guang-Chao Yang, Ya-Xian Mo, Wei-Hua Zhang, Li-Bin Zhou, Xu-Ming Huang, Department of Gastroenterology, Shenzhen Shiyan People's Hospital, Shenzhen 518000, Guangdong Province, China
Li-Ming Cao, Department of Internal Medicine, Shenzhen University The First Affiliated Hospital, Shenzhen 518000, Guangdong Province, China
Author contributions: Yang GC and Mo YX contributed equally to this work; Yang GC and Mo YX performed the research and revised the manuscript; Zhang WH and Zhou LB provided and analyzed the data; Huang XM designed the study and wrote the manuscript; Cao LM reviewed and revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient. We obtained written consent for publication from the patient.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Received: October 6, 2021 Peer-review started: October 6, 2021 First decision: October 27, 2021 Revised: November 7, 2021 Accepted: December 25, 2021 Article in press: December 25, 2021 Published online: February 6, 2022
Abstract
BACKGROUND
Bleeding from gastroesophageal varices (GOV) is a serious complication in patients with liver cirrhosis, carrying a very high mortality rate. For secondary prophylaxis against initial and recurrent bleeding, endoscopic therapy is a critical intervention. Endoscopic variceal clipping for secondary prophylaxis in adult GOV has not been reported.
CASE SUMMARY
A 66-year-old man with cirrhosis was admitted to our hospital complaining of asthenia and hematochezia for 1 wk. His hemoglobin level and red blood cell counts were significantly decreased, and his fecal occult blood test was positive. An enhanced computed tomography of the abdomen showed GOV. The patient was diagnosed with hepatitis B cirrhosis-related GOV bleeding. A series of palliative treatments were administered, resulting in significant clinical improvement. Subsequently, an endoscopic examination revealed severe gastric fundal varices, prompting endoscopic variceal clipping. There were no further episodes of gastrointestinal bleeding. The GOV improved significantly on follow-up imaging and was confirmed as improved on endoscopy at the 5th postoperative month.
CONCLUSION
Our results suggest that endoscopic clipping is an inexpensive, safe, easy, effective, and tolerable method for the secondary prophylaxis of bleeding from gastric type 2 GOV. However, additional research is indicated to confirm its long-term safety and efficacy.
Core Tip: Gastrointestinal bleeding as a sequela of portal hypertension can be catastrophic and fatal. For patients without secondary prevention, the rebleeding and mortality rate is high; therefore, secondary prophylaxis is vital, and endoscopic techniques are primary methods used to perform this. Our novel endoscopic technique could play a critical role in the prevention of variceal re-bleeding, and we propose that it is a safe and efficacious method for the secondary prophylaxis of Type 2 GOV rebleeding. Our work provides an idea for the further study in this field.
