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DOI: 10.1055/a-2638-5775
Endoscopic titanium clip with nylon loop for treating esophageal and gastric variceal bleeding after endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt
Supported by: Chongqing Health Appropriate Technology Promotion Project 2022jstg033
Supported by: Second Affiliated Hospital of the Army Military Medical University Incubation program project of Young Doctoral Talents 2024YQB077
A 49-year-old man experienced intermittent hematemesis and melena for over a decade. He was diagnosed with decompensated liver cirrhosis secondary to chronic hepatitis B more than 10 years ago and has since been managed conservatively with pharmacotherapy. He presented to a local hospital 8 days ago with recurrence of hematemesis and underwent endoscopic variceal ligation (EVL). Following stabilization, he was transferred to our department for a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
On postoperative Day 3, the patient developed recurrent hematemesis. After fluid resuscitation and blood transfusion, an urgent gastroscopy revealed esophageal and gastric varices combined with multiple ulcers, including an ulcer of about 1 cm in diameter located on a varicose vein at the cardia with active bleeding. Re-ligation was not feasible. Therefore, we utilized titanium clips with nylon loop to suture the ulcer surface, successfully controlling the hemorrhage ([Video 1]).
Endoscopic titanium clip and nylon loop for treating variceal bleeding after endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt.Video 1The patient’s condition improved following postoperative management, including continued fluid resuscitation and measures to reduce portal pressure, and he was subsequently discharged.
Although EVL is regarded as one of the most effective treatment modalities for esophageal varices, post-EVL bleeding remains a significant clinical challenge [1]. TIPS has been shown to be more efficacious in reducing rebleeding and rebleeding-related mortality rates in patients with cirrhotic esophageal varices [2]. Despite subsequent TIPS intervention, this patient experienced recurrent bleeding. Consequently, for patients who exhibit early bleeding following EVL combined with TIPS, the application of titanium clips with nylon loop can serve as an effective and timely remedial measure for achieving emergency hemostasis.
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Publication History
Article published online:
14 August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406-460
- 2 Jing L, Zhang Q, Chang Z. et al. Nonsurgical secondary prophylaxis of esophageal variceal bleeding in cirrhotic patients: a systematic review and network meta-analysis. J Clin Gastroenterol 2021; 55: 159-168