PMC2862315_01
GOV before EIS. (a, b) UGIE showed large, tense, and winding EV with cherry red spots extending down to lesser curve.
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A 68-year-old Japanese man with hemophilia A and liver cirrhosis was referred to our hospital because of large, tense, and winding EV with cherry red spots extending from middle esophagus down to lesser curve, classified as type 1 GOV (GOV1) (Figures 1(a) and 1(b)).
EIS procedure. (a) EIS was performed by intravariceal injection of 15 mL of 5% EOI in total. (b) Radiographic imaging showed that 5% EOI reached the cardiac plexus and LGV.
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Esophageal EIS was performed by intravariceal injection with a total 15 mL of 5% ethanolamine oleate with iopamidol (EOI) for three varices at middle esophagus (Figure 2(a)). Radiographic imaging during EIS demonstrated that 5% EOI reached the LGV, which was the afferent vein of the GOV (Figure 2(b)).
GOV seven days after EIS. (a, b) UGIE showed that the varices were eradicated almost completely without cherry red spots. (c) EUS showed high echoic areas in the lumen of the varices, indicating that the varices were completely thrombosed after EIS.
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Seven days after EIS, upper gastrointestinal endoscopy (UGIE) showed that the varices were eradicated almost completely without cherry red spots (Figures 3(a) and 3(b)), and endoscopic ultrasonography (EUS) showed high echoic areas in the lumen of the varices (Figure 3(c)), indicating the formation of thrombi in the afferent vessels as well as the varices.
GOV eighteen months after EIS. (a, b) Follow-up endoscopy showed that the varices continued to shrink.
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At follow-up endoscopy eighteen months after the treatment, the varices continued to diminish without visible cherry red spots (Figures 4(a) and 4(b)), however, the appearance of esophageal telangiectasia and portal hypertensive gastropathy was observed.