Ruptured varix: tips to tackle the demon

Vishal Ghevariya, MD, from Eden Medical Center in Castro Valley, California, USA describes this video case “Ruptured varix: tips to tackle the demon.”

A 36-year-old man with alcohol induced liver cirrhosis presented with hematemesis. After initial resuscitation, an upper endoscopy was performed. Several columns of Grade III varices were noted in the esophagus. Two fibrin plugs were noted on a single column and one fibrin plug on an adjacent varix, all equidistant from the incisors. Ligation of 2 fibrin plugs on a varix was achieved with a single band. Attempt to band the second variceal plug resulted in rupture of the varix and profuse bleeding ensued. The bleeding varix was compressed using the cap of the endoscope to identify the direction of blood flow and achieve hemostasis while sclerotherapy could be performed. Visualization was maintained with intermittent irrigation of water through auxiliary water jet.

  1. This video represents a case of varices with multiple fibrin platelet plugs (or white nipples) in the vicinity of each other.
  2. The video demonstrates how to grasp 2 nipples on a single varix by accurately aligning the cap band device.
  3. The video demonstrates meaningful use of auxiliary water jet to improve visualization.

Gastroenterology fellows would certainly benefit from watching this video if they have not encountered such a unique situation in their training. Moreover, teaching faculty can easily use this video to facilitate learning.

Figure 1. Endoscopic view of 2 fibrin platelet plug on a single varix.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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