Abstract
A male in his 60’s had undergone hepatectomy twice to treat hepatocellular carcinoma and intrahepatic bile duct cancer, as well as proximal gastrectomy for gastric cancer. The patient had been diagnosed with esophageal varices (EV) caused by alcohol-related cirrhosis (Child Pugh A) and was treated by EVL/EIS in 2010. EV recurred (Lm, F2, Cb, RC＋) and were treated by EVL again in February 2012. Additional EVL was conducted seven days after the first EVL. Three days after the second treatment, the patient suddenly vomited blood. Emergency endoscopy was performed, and confirmed spurting hemorrhage from the F0 varix close to the esophago-gastric anastomosis, with EV in the scar site. It was not possible to ligate the bleeding point using EVL due to the presence of scars. EIS was not effective as the mucosa was too hard to penetrate using the injection needle. Finally, the bleeding was successfully controlled using an endoscopic clipping device. Fortunately, it was facile as the bleeding point was clearly visible. In general, EVL or EIS are chosen to stop bleeding of EV and endoscopic clipping is rarely used as a hemostatic device. However, when the bleeding cannot be controlled using standard devices─such as in this case─we should consider endoscopic clipping as an option.
