European Journal of Biomedical and Pharmaceutical Sciences

PLACEMENT OF A TRANS-JUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AS “SALVAGE” THERAPY IN A PATIENT WITH PERSISTENT BLEEDING FROM ESOPHAGEAL POST-BANDING ULCERS

Natalia G. Vallianou PhD*, Periklis Bobolas PhD, Angeliki Christidou MD, Maria Mela PHD, Elias Mproutzos MD and Peter C. Avgerinos PhD

ABSTRACT

Local re-bleeding from post-banding ulcers (PBUs) is a relatively unusual complication of emergency endoscopic variceal band ligation (EVBL) of esophageal varices. It is usually observed one to three weeks after EVBL and represents a high-mortality situation due to the limited options for bleeding control and the morbidity associated with the underlying liver disease. In this report, we describe a female patient who had a positive outcome following a “salvage” trans-jugular intrahepatic portosystemic shunt (TIPS), when the combined pharmacologic and endoscopic therapies failed to control her bleeding from PBU. Although this sequence of therapeutic approaches has been established as the standard approach for bleeding by esophageal varices, no consensus exists so far in applying the same strategy for uncontrolled bleeding by PBU.

Keywords: Endoscopic Variceal band ligation (EVBL); Re-bleeding from post banding ulcers (PBUs); Trans-jugular intrahepatic portosystemic shunt (TIPS).