An emergency hybrid procedure that combines endoscopic treatment with partial splenic embolization for bleeding esophagogastric varices

Abstract

Management of splenomegaly is important in the treatment of portal hypertension. We report 2 cases who were treated by an emergency hybrid procedure combining endoscopic treatment and partial splenic embolization (PSE) based on a new concept ''splanchnic caput Medusae''. Case 1 with refractory esophageal variceal bleeding due to alcoholic liver cirrhosis was treated by endoscopic injection sclerotherapy (EIS) with ligation and PSE at the same time. Case 2 with gastric variceal bleeding due to polycystic liver disease was treated by EIS using n-butyl-2-cyanoacrylate and PSE at the same time. Six days after the hybrid procedure, transjugular retrograde obliteration was added. In both cases, post-treatment 3D-CT reconstruction images revealed that the spleen-portal system reversed to almost normal form. We conclude that an emergency hybrid procedure combining endoscopic treatment and PSE is effective for patients with bleeding esophagogastric varices.

Keywords

• Emergency hybrid procedure
• Splanchnic caput Medusae
• Esophagogastric varices
• Endoscopic injection sclerotherapy
• Partial splenic embolization
• Polycystic liver disease