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Z Gastroenterol 2016; 54(12): 1320-1326
DOI: 10.1055/s-0042-117227
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Multimodal therapy of recurrent and refractory bleeding from esophageal varices – case report and review of the literature

Sequenzielle multimodale Therapie rekurrenter refraktärer Ösophagusvarizenblutung – ein Fallbericht mit Literaturdiskussion
M. Buechter
1   Department of Gastroenterology and Hepatology, University Hospital Essen, Germany
,
V. Penndorf
1   Department of Gastroenterology and Hepatology, University Hospital Essen, Germany
,
A. Canbay
1   Department of Gastroenterology and Hepatology, University Hospital Essen, Germany
,
J. M. Theysohn
2   Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
,
A. Dechêne
1   Department of Gastroenterology and Hepatology, University Hospital Essen, Germany
› Author Affiliations
Further Information

Publication History

21 July 2016

08 September 2016

Publication Date:
22 November 2016 (online)

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Abstract

Bleeding from esophageal varices is a major cause of mortality in patients with advanced liver disease. Although standard treatment and secondary prophylaxis are effective, in some patients sustained hemostasis cannot be achieved.

We report the case of a woman with alcoholic liver disease in whom pharmacological, endoscopic, and intravascular therapies failed to control variceal bleeding. Only a combination of (repeated) band ligation, insertion of a self-expanding metal stent, TIPS implantation and redilatation, transjugular variceal embolization, and finally implantation of a portocaval shunt proved to be successful. We discuss the stepwise approach to this situation and the challenges encountered in the process.

Zusammenfassung

Ösophagusvarizenblutungen sind eine häufige Todesursache von Patienten mit fortgeschrittener Lebererkrankung. Auch endoskopische Standardbehandlungsmethoden und eine medikamentöse Sekundärprophlyaxe können nicht in allen Fällen eine refraktäre oder rezidivierte Blutung verhindern.

Wir berichten den Fall einer Patientin mit alkoholischer Lebererkrankung, bei der pharmakologische, endoskopische und intravaskuläre Therapiemodalitäten nicht zur Blutstillung führten. Erst eine Kombination aus wiederholten Gummibandligaturen, Einlage eines selbst expandierenden Metallstents (SEMS), Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS), retrograder Varizenembolisation und schließlich chirurgischer Anlage eines portosystemischen Shunts führten zur dauerhaften Hämostase. Wir diskutieren das schrittweise Vorgehen und die Herausforderungen bei der Behandlung.

Schlüsselwörter

Portale Hypertension - Gastrointestinale Blutung - Ösophagusvarizen - TIPS - Selbst expandierende Metallstents (SEMS)

Key words

portal hypertension - gastrointestinal bleeding - esophageal varices - TIPS - self-expanding covered metal stents (SEMS)
 

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