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Bleeding From a Duodenal Varix: A Unique Case of Variceal Hemostasis Achieved Using EUS-guided Placement of an Embolization Coil and Cyanoacrylate

Kinzel, Jason MD; Pichetshote, Nipaporn MD; Dredar, Serag MD; Aslanian, Harry MD; Nagar, Anil MD

Journal of Clinical Gastroenterology: April 2014 - Volume 48 - Issue 4 - p 362–364
doi: 10.1097/MCG.0000000000000004

We report a case of a bleeding duodenal varix demonstrating excellent hemostasis achieved by endoscopic ultrasound (EUS)-directed placement of an embolization coil followed by cyanoacrylate. A 31-year-old man with decompensated Child’s class C cirrhosis presented with hematemesis. An initial endoscopy revealed an actively bleeding duodenal varix. Subsequent attempt at hemostasis with ethanolamine oleate injection failed. A later attempt at hemostasis involving EUS-guided placement of an embolization coil followed by cyanoacrylate injection into the varix was successful. We reviewed the literature involving the treatment of bleeding ectopic varices and conclude that EUS provides a unique and advantageous modality for achieving variceal hemostasis of duodenal varices in patients who are not candidates for transjugular intrahepatic portosystemic shunt.

Yale University School of Medicine-Yale New Haven Hospital, New Haven, CT

H.A.: Consultant for Boston Scientific and Olympus Corporation. The remaining authors declare that they have nothing to disclose.

Reprints: Jason Kinzel, MD, 758 Quinnipiac Avenue, New Haven, CT 06513 (e-mail:

© 2014 by Lippincott Williams & Wilkins