Post written by Kar Wai Lau, MBBCh, BAO (Hon), MD, FRCP, from the Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom.

This is a case of a patient who presented with significant upper GI bleeding with hemodynamic compromise. She had a history of alcohol excess, and there was suspicion of variceal bleeding.

Endoscopy performed with a forward-viewing gastroscope was unsuccessful in locating the source of bleeding. Subsequent use of a side-viewing duodenoscope permitted optimal visualization of a duodenal varix as the source of bleeding at the index endoscopy. Duodenoscopy also allowed optimal application of treatment with n-butyl-2-cyanoacrylate (Histoacryl, B. Braun, Melsungen, Germany) glue injection. Endoscopic treatment of ectopic varices in the duodenum is feasible and safe.

Ectopic varices are difficult to diagnose and treat, with patients undergoing numerous investigations before the eventual diagnosis. Simple measures such as use of a different type of endoscope enabled diagnosis and successful endoscopic treatment in this case at the index endoscopy.

Be familiar with the use of a duodenoscope and options available for treatment of ectopic varices. The video also provides a step-by-step guide for successful injection of glue and minimization of technical errors.

Clear view of the duodenal varix with a side-viewing duodenoscope.

Read the full article 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.