Implantation of self-expanding metal stent in the treatment of severe bleeding from esophageal ulcer after endoscopic band ligation.

Endoscopic variceal ligation is superior to sclerotherapy because of its lower rebleeding and complication rates. However, ligation may be associated with life-threatening bleeding from postbanding esophageal ulcer. We report a case of a 49-year-old male with massive hemorrhage from esophageal ulcer on 8th day after successful band ligation of bleeding esophageal varices caused by postviral liver cirrhosis (Child-Pugh class C). A removable polyurethane membrane-covered self-expanding metal stent (SX-ELLA stent Danis, 135 mm × 25 mm, ELLA-CS, Hradec-Kralove, Czech Republic) was inserted in ICU for preventing fatal hemorrhage. Complete hemostasis was achieved and stent was removed after 8 days without rebleeding or any complications. To the best of our knowledge, this is the first report in English literature regarding life-threatening hemorrhage from postbanding esophageal ulcer successfully treated by self-expanding metal stent in a patient with portal hypertension.

Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case.

Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature.