Management of a Bleeding Ulcer by Post-esophageal Ligation of Varices with Self Expanding metal Stents: Case Report and Literature Review

Abstract

Early treatment of bleeding varices with direct compression dates from the work by Westphal et al. in 1930. Later in 1950, Sengstaken-Blakemore developed their balloon which Panes and collaborators defined as the first line of therapy for esophageal varices in 1980 while they used the Linton-Nachlass balloon for gastric varices (1, 2).
This study presents the clinical case of a patient with liver cirrhosis due to hepatitis C, (Child B) with esophageal varices which were ligated on two different occasions because of bleeding. On the second occasion a
rupture was imminent and ligation occurred two weeks prior to the event. The patient presented a clinical picture compatible with massive upper gastrointestinal bleeding with endoscopic evidence of a bleeding
esophageal ulcer that did not improve with terlipressin, sclerotherapy with adrenaline, or balloon dilatation. Consequently, it was to use a partially covered self-expanding metal esophageal stent for salvage therapy since a completely covered stent was not available at that time. Stenting achieved partial control of bleeding. We recommend the use of stenting with a stent specifically designed for this indication (SX-Ella Danis) as salvage therapy for refractory bleeding from esophageal varices. The stent can be used as a bridge to stabilize the patient in order to perform TIPS as the definitive treatment, as in the case of our patient.