Bleeding from Ectopic Duodenal Varices: TTS clip an easy, effective and potential alternative to cyanoacrylate injection in an emergency setting

Ectopic varices, particularly those situated in the duodenum, present a substantial clinical challenge due to their infrequency and propensity for bleeding. Although glue injection has proven effective, its availability is limited and it necessitates a certain degree of technical expertise. This case report seeks to assess the efficacy of hemostatic through-the-scope (TTS) clips as an alternative therapeutic approach especially in emergency scenarios.

A case study was undertaken involving a young 40 years old patient diagnosed with portal hypertension secondary to portal vein thrombosis who was admitted to the emergency department after a an episode of Upper gi bleed. On endoscopy there was bleeding for an ectopic duodenal varices right on the level of the genus superus. The intervention comprised the strategic placement of two hemostatic TTS clips flanking the bleeding site, with the primary objective of obstructing the blood supply and achieving hemostasis [1].

The deployment of hemostatic TTS clips resulted in successful hemostasis, with no subsequent episodes of bleeding. This favorable outcome corroborates a similar success reported in the literature by Park & al. employing this technique from which we were inspired.

Additional research is warranted to further substantiate these findings.

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Artikel online veröffentlicht:
27. März 2025

• References

• 1 Park S.B., Lee S.H., Kim J.H., Lee H.J., Jang S.P., Lee J.N., Hwang J.H.. Successful treatment of duodenal variceal bleeding by endoscopic clipping. Clinical endoscopy 2013; 46 (4): 403-406