A Combined Treatment of Life-threatening and Difficult to Treat Bleeding Gastro-oesophageal Varices in a Patient with Cirrhosis and Portal Cavernomatosis

Authors

  • Simone Di Cola Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy Author
  • Adriano De Santis Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy Author
  • Emanuela De Santis Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy Author
  • Piergiorgio Nardis Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy Author
  • Stefano Pontone Department of Surgical Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy Author
  • Mario Corona Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy Author
  • Pierleone Lucatelli Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy Author

DOI:

https://doi.org/10.47363/JGHR/2022(3)146

Keywords:

Cirrhosis, Gastroesophageal Varices, Portal Cavernomatosis, Balloon-Occluded Retrograde Trans-Venous Obliteration(Brto), Primary Prophylaxis, Transjugular Intrahepatic Portosystemic Shunt (Tips), Variceal Band Ligation, Case Report

Abstract

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular secondary prophylactic approach to gastroesophageal variceal (GOV) bleeding. However, standard primary prophylaxis is olten inef-fective and GOV bleeding is more severe than esophageal variceal (EV) bleeding. Portal vein thrombosis and its evolution to cavernomatosis are common complications of cirrhosis. There are no data in the literature on the safety of BRTO in patients with portal cavernomatosis and on the risk of excessively increasing portal hypertension in patients with esophageal varices at risk of bleeding. Portal cavernomatosis is a relative con-traindication to TIPS placement. Furthermore, in our knowledge there are no great experiences on the com-bined use of BRTO and TIPS and no information in patients with portal cavernomatosis.
We report the case of a 66-year-old woman with hepatitis C virus-related liver cirrhosis. The patient had re-current EV bleeding, the new onset of a large GOV2, and portal cavernomatosis. We performed EV band lig-ation (EVBL) followed by BRTO to treat the GOV2, which had not bled previously. No complications occurred and an improvement in liver tests was observed alter treatment. Following a further episode of bleeding from esophageal varices we decided to perform TIPS placement.
The combination of EVBL and BRTO as primary prophylaxis of GOV2 bleeding is safe and effective also in patient with portal cavernomatosis. An improvement in liver tests was also observed, likely due to increased portal flow through the cavernoma. The combined use of BRTO and TIPS is safe and effective to control esophageal and gastroesophageal varices.

Author Biographies

  • Simone Di Cola, Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy


    Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy

  • Adriano De Santis, Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy

    Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy

  • Emanuela De Santis, Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy

    Department of Translational and Precision Medicine, Sapienza University, Viale Dell’Università 37, 00185, Rome, Italy

  • Piergiorgio Nardis, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

    Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

  • Stefano Pontone, Department of Surgical Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

    Department of Surgical Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

  • Mario Corona, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy


    Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

  • Pierleone Lucatelli, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

    Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

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Published

2022-10-22

Issue

Vol. 3 No. 4 (2022): Volume 3 Issue 4

Section

Articles