2023 Volume 65 Issue 10 Pages 2174-2179
A 78-year-old man with intrahepatic cholangiocarcinoma was followed up after the right lobectomy of his liver. He subsequently developed tarry stools and underwent endoscopy, which revealed esophageal varices (LmF3CwRC1). No hepatic encephalopathy was evident, but at 107 μg/dL, the ammonia level was elevated. As the patient had a low platelet count of 50,000/μL, he was administered 3 mg/day Lustrombopag for a week, which increased the count. Endoscopic sclerotherapy was then performed, using ethanolamine olate to occlude the left gastric vein. Thereafter, the ammonia level normalized rapidly. Portal hypertension sometimes occurs after hepatectomy, and esophageal varices may develop. Occluding the giant tree-like esophageal varices using endoscopic sclerotherapy is considered to block the collateral blood circulation, resulting in a decrease in the ammonia level. In patients with esophageal varices and a high ammonia level, shunt occlusion may reduce the ammonia level. This was also considered to be the appropriate active intervention in the present case of pipeline esophageal varices after hepatectomy in which the ammonia level normalized after endoscopic sclerotherapy.
