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The bleeding dilemma# (the maze of upper GI bleeding#)

December 09, 2019

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colonoscopy for beginners (young gastroenterologists)

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calm before the storm

Calm before the storm. A 75-year-old man underwent an upper digestive endoscopy because of a massive attack of hematemesis five days ago. The hemoglobin level was 4 gm/ dl. A blood transfusion was given, and hemoglobin is 9 gm/dl. The patient has a history of chronic liver disease and an upper digestive endoscopy two years ago. The index endoscopy revealed gastric varices that were injected with amacrylate. The second endoscope revealed a sizeable gastric varix with a bleeding point (triangular in part 1 of the video). Just after identification, the varix begins to bleed during the endoscopy (part 2, beginning of the storm). The varix was secured with five ampoules of the amacrylate (part 3 of the video). After the injection of amacrylate, another storm (volcano) of bleeding started. The endoscopist injected the varix again with five ampoules of amacrylate. This time, you can notice the glue protruding from the bleeding point (arrow). After the endoscopy, the patient was admitted to th

60 -year -old female patient presented with upper GI bleeding 2 months ago. Upper GI endoscopy revealed GII esophageal varices that were ligated at 2 sessions of endoscopy. also, there were small gastric varices in the first endoscopy, but in the third session of upper GI endoscopy, gastric varix became prominent so it was injected with 5 amp amacryl plus lipiodol.

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