A Case of Successful Treatment with an Intraportal Expandable Metallic Stent for Esophageal Variceal Bleeding by Hemostasis of the Collateral Flow

Kiyoshi Ishigure, Shin Takeda, Tetsuya Kaneko, Soichiro Inoue and Akimasa Nakao

Department of Surgery II, Nagoya University

We report successful hemostasis with interventional radiology using an intraportal expandable metallic stent (EMS) for esophageal variceal bleeding caused by portal vein invasion of a hilar cholangiocarcinoma. A 65-year-old man admitted for tarry stool and anemia had a history of biliary stent placement for unresectable hilar cholangiocarcinoma 1 year earlier. Close examination showed that hematemesis was due to rupture of esophageal varices formed under portal hypertension caused by portal vein invasion of hilar cholangiocarcinoma. Despite endoscopic injection sclerotherapy, variceal bleeding was not controlled. An EMS was placed with interventional radiology for hemostasis of the collateral flow. After stent placement, no esophageal varices and bleeding were confirmed but the hepatopetal portal flow in the EMS was not sufficient. The patient recovered satisfactorily and was discharged. Intraportal EMS placement is considered nonaggessive and effective in treating gastrointestinal bleeding caused by malignant portal obstruction.

Key words
expandable metallic stent, malignant stenosis of the portal vein, esophageal varices

Reprint requests
Kiyoshi Ishigure Department of Surgery, Chuno-Hospital 5-1 Wakakusa-dori, Seki, 501-3802 JAPAN

Accepted
February 26, 2003

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