#Nodule at the cardia in a patient with bleeding esophageal varices#

A 64-year-old man presented with recurrent attacks of upper gastrointestinal bleeding was admitted to the GI unit. The patient gives a history of advanced HCC (on supportive treatment) and a similar attack of upper GI bleeding 7 months ago. In the previous attack, upper digestive endoscopy revealed esophageal varices that were ligated at this time. The patient underwent upper GI endoscopy. The scope revealed a nodule at the cardia and large esophageal varices.

What is your opinion?

1-      Band ligation for both the nodule and varices

2-      Band ligation for the varices only, discard the nodule

3-      Band ligation for the varices with biopsies from the nodule

4-      Others

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