World Congress of Gastroenterology

WCOG 2019


 
MANAGEMENT OF DUODENAL VARICES & PORTAL BILIOPATHY
Malay sharma 1 MAHESH PATIL 1 Gaurav Ratnaparkhi 1 NIKHIL MAHAJAN 1 SUNIL REDDY 1 Sarthak Atri 1

1- JASWANT RAI SPECIALITY HOSPITAL
 
Abstract:

Bleeding during ERCP is a serious problem and can occur due to many reasons. We present a 22-year-old male, a known case of EHPVO presented with massive hematemesis and jaundice. Ultrasound showed dilated intra-hepatic bile duct. MRI and MRCP abdomen showed IHBRD. Endoscopy showed no esophageal varices, portal gastropathy and thickened duodenal fold. The thickened fold appeared suspicious of duodenal varices (DV) but no bleeding was demonstrated.

Endoscopic ultrasound confirmed that the presence of DV. The DV was assumed to be the cause of bleed and EUS guided microcoil and 1 ml of cyanoacryalate glue was placed into the duodenal varix. He also had obstructive cholestatic jaundice secondary to Portal biliopathy (PB). During placement of a plastic stent in the bile duct massive bleeding started. Haemostasis was achieved by placing an expandable covered stent within the bile duct. The stent was removed after three weeks. After removal of the stent spy glass cholangioscopy showed bleeding from multiple cherry-red spots in the CBD wall. There were no intra-choledochal varices. Patient remained stable during follow-up for six months but required repeat ERCP and plastic stent placement for management of stricture related to PB.

To conclude we can say that EUS is an important diagnostic & therapeutic intervention modality in cases of DV bleed. PB may be associated with massive bleed during therapeutic intervention. Expandable covered stent should be used to control intractable bleeding.

 

Keywords:

GI bleeding, Endoscopic ultrasound, Portal biliopathy