A 62-year-old man who presented
with a massive attack of hematemesis and melena (recurrent attacks despite
regular follow-up for esophageal varices) was admitted to the endoscopy unit. The
patient gives a history of coronary stents and clopidogrel 75m g therapy. The patient
underwent upper digestive endoscopy. The scope revealed risky varices. Band ligation
was done.
What will you do?
1-
I will begin at the lower
esophageal sphincter and ligate varices till I reach the riskiest varices, then
ligate them.
2-
I will do targeted therapy, and ligate the
riskiest varices first, then ligate or not the other varices.
What is your opinion about the most
protruding varices?
1-
Naturally occurring.
2-
incomplete detachment of
previously. banded varices
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