Duodenal Variceal Bleeding Successfully Treated by Endoscopic N-butyl-2-cyanoacrylate Injection

∗ Corresponding author. E-mail address: [email protected] (M. Costa). therapeutic procedures have not yet been established for bleeding from duodenal varices. Endoscopic band ligation, sclerotherapy, transjugular intrahepatic portosystemic shunt, balloon-occluded retrograde transvenous obliteration, and resection of a segment of bleeding site have been used for treatment.2--5 We present a case of a 48-year-old man with a known history of liver cirrhosis secondary to chronic hepatitis C infection. He was admitted in emergency department due to hematemesis and melena for 24 h. He was hemodynamically stable, and had a hemoglobin level of 7.1 g/dL. The patient was treated with intravenous (IV) pantoprazole, IV octreotide and IV cetfriaxone. Emergency esophagogastroduodenoscopy revealed small esophageal varices without stigmata of hemorrhage. Apart frommild portal gastropathy, no other gastric lesions suggestive of bleeding were noted. Finally, a duodenal varix with a fibrin plug at the second portion, approximately 1 cm in diameter, was found (Fig. 1). N-butyl-2-cyanoacrylate (histoacryl) was injected to the duodenal varix, and bleeding was successfully controlled. Subsequently, the patient remained hemodynamically stable, with no recurrent bleeding. Six months later, a follow-up endoscopy showed large esophageal varices, which were treated with endoscopic band ligation, and severe hypertensive gastropathy. There were not any signs of duodenal varices (Fig. 2).