There are limited efficacious therapeutic options for management of gastric variceal bleeding. Treatment modalities include transjugular intrahepatic portosystemic shunt, surgical shunts, and endoscopic interventions, including the recent advancement of endoscopic ultrasound (EUS)‐guided coiling. We present a case series of 10 patients with portal hypertension (7 with liver cirrhosis and 3 without cirrhosis), complicated by gastric varices (GV) with bleeding. All cases were treated successfully with EUS‐guided coiling leading to variceal eradication. There were 10 occurrences of minimal self‐limited bleeding at the puncture site during the procedure, and only one occurrence of major bleeding that necessitated cyanoacrylate glue injection for homeostasis. There were no other adverse events within a mean follow‐up time of 9.7 months (range, 1‐28 months). Conclusion: In our series, EUS‐guided angiotherapy was effective for GV eradication with a high safety profile.
One hundred forty consecutive cancer patients had percutaneously placed subclavian vein catheters for up to 882 days' duration. The incidence of suspected and proven catheter-related sepsis was low. This is a cost-effective alternative to tunneled catheter insertion for chronic venous access in cancer patients.
Bacteremia can result very unusually in significant complications after esophageal dilation. Procedure-related mucosal trauma may be a determinant, whereas pathogenic bacteria primarily originate from the patient's oropharyngeal flora. We describe an unusual case of Streptococcus agalactiae bacteremia and shoulder girdle abscess complicating esophageal bougienage. Consideration of specific risk factors and use of scrupulous procedural technique are warranted and will likely reduce pyogenic sequelae.
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