Frischtak Helena L, Davis Jessica P, Shah Neeral L
School of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
BMJ Case Rep. 2017 Aug 11;2017:bcr-2017-219615. doi: 10.1136/bcr-2017-219615.
A 56-year-old male with cirrhosis presented with acute bleeding from cardiofundal gastroesophageal varices (GOV) and was treated with endoscopic cyanoacrylate glue. Glue therapy achieved stabilisation of the patient in the emergent setting. Three months later, the patient suffered rebleeding. At that time, he underwent retreatment with balloon-occluded retrograde obliteration (BRTO), with no recurrence at a follow-up of 14 months.Available treatments for bleeding GOV include methods to (a) directly obstruct the varices (endoscopic variceal ligation , sclerotherapy and cyanoacrylate glue, BRTO) or to (b) decrease portal pressure (surgical portacaval shunts; transportal intrahepatic portosystemic shunt). No precise guidelines are available regarding when to use which modality, and few centres have experience with all of them. This case report illustrates a setting in which both options of cyanoacrylate glue therapy and BRTO were used for acute gastric variceal bleeding.
一名56岁的肝硬化男性患者因贲门胃底食管静脉曲张（GOV）急性出血，接受了内镜下氰基丙烯酸酯胶治疗。胶治疗在紧急情况下使患者病情稳定。三个月后，患者再次出血。当时，他接受了球囊闭塞逆行栓塞术（BRTO）再次治疗，在14个月的随访中无复发。治疗出血性GOV的可用方法包括：（a）直接阻塞静脉曲张（内镜下静脉曲张结扎术、硬化疗法和氰基丙烯酸酯胶、BRTO）或（b）降低门静脉压力（外科门腔分流术；经颈静脉肝内门体分流术）。关于何时使用哪种方式，尚无精确的指南，很少有中心对所有这些方法都有经验。本病例报告说明了氰基丙烯酸酯胶治疗和BRTO这两种选择均用于急性胃静脉曲张出血的情况。
