Endoscopic Treatment of Refractory Variceal Bleed
A 70-year-old man with history of end-stage liver disease due
to alcohol misuse disorder was admitted to the hospital with
hematemesis.
He had at least 5 episodes of bright red hematemesis
and was feeling dizzy.
He complained of epigastric pain for 3 days
prior to presentation.
He had noticed progressive development of
dark urine, pale stools and yellow sclera.
He had not consumed any
non-steroidal anti-inflammatory drugs recently.
His last consumption of alcohol was 3 months ago. He had a prior history of gastrointestinal bleeding and had undergone upper GI endoscopy that revealed large varices with high risk stigmata (white nipple sign) requiring variceal band ligation.
His last endoscopy was 6 weeks prior to presentation.
He was noncompliant with prophylactic propranolol and was not on any other
medications.
On physical examination, patient appeared chronically ill,
pale with evidence of scleral icterus and spider nevi. He was alert
and in apparent discomfort due to recent vomiting and retching.
His BP was 90/50 mmHg with a pulse of 110/minute. He was afebrile.
Pertinent laboratory studies revealed hemoglobin of 6 g/dL,
platelets of 40,000 µL and INR of 2.2. His model for end-stage
liver disease (MELD)-Na was calculated to be 25.
Gastro Open J. 2019; 4(1): 1-3. doi: 10.17140/GOJ-4-128
