And 19 months later, the gastric varix was disappeared (Figure 1D). In the follow-up period of 19 months, this patient had no further episodes of variceal bleeding. Case 2 A 60-year-old male visited the hospital for melena lasting for 1 week. He had a medical history of alcoholic cirrhosis, type 2 diabetes mellitus and cerebral infarction. Melena started one week before the visit, without significant incentive and other specific symptoms. Vital signs at admission were measured as blood pressure 126/68 mmHg, pulse rate Daporinad mouse 87/min, respiration rate
18/min, and body temperature 36.7°C. Not pale conjunctiva and anicteric sclera was found at physical examination. Hepatic face and liver palms were observed but no spider angioma. Cardiac and respiratory examinations were
MAPK Inhibitor Library normal. There was splenomegaly with no tenderness in the left hypochondrium. Laboratory findings were as follows: hemoglobin 9.0 g/dL; hematocrit 32%; leukocyte 1 730 cells/mm3, neutrophil 62.1%; platelets 157 000/mL; total bilirubin 0.70 mg/dL; serum albumin 3.92 g/dL; gamma-glutamyl transpeptidase (GGT) 62 U/L; prothrombin time 15.6 s and alpha-fetal protein 30.35 ng/ml. Neither ascites nor encephalopathy was observed. Child-Pugh’s classification was graded as A. Abdominal contrast -enhanced computed tomography showed liver cirrhosis with gastric varices and splenomegaly. The following day of admission, endoscopy demonstrated the esophageal and fundus varices are present in continuity over the cardia with an overlying red spot, consistent with a recent bleeding (Figure 2A). Cyanoacrylate and lipiodol were injected into one of the gastric varices by the sandwich method. After operation, PPI, octreotide, hemostatics and hepatinica were given. The patient was
no obvious complication and was discharged Teicoplanin on the third day postoperatively. One month later, the patient was admitted to hospital for prophylactic esophageal variceal ligation. Gastric varices shrunk obviously and mucosal erosion was noted in site of injection (Figure 2B). An endoscopy performed 4 months post injection of cyanoacrylate showed residual ulcer in the site of injection and moderate esophageal varices without gastric varices (Figure 2C). So endoscopic nylon endoloop was performed for 3 times at 4, 7, 10 months. A followed-up endoscopy performed 21 months after initial injection of cyanoacrylate revealed esophageal gastric varices were disappeared (Figure 2D). Conclusion: Gastric varices eradicated in the two patients and no obvious complications occurred. Key Word(s): 1. gastric varices; 2. cyanoacrylate; 3.