A 66-year-old woman with hepatitis C virus-related cirrhosis was referred to our institution for endoscopic management of large isolated gastric varices. She was recently admitted to another hospital for melena and hepatic encephalopathy. Esophagogastroduodenoscopy (EGD) during that hospitalization showed large gastric varices without significant esophageal varices. Given that no active bleeding was seen during endoscopy, no endoscopic intervention was performed, and she was conservatively managed with plans for outpatient follow-up after discharge. Repeat EGD at our center showed large isolated gastric fundic varices (Figure 1), with overall cluster measuring around 3.5 cm. Endoscopic ultrasound (EUS)-guided coil embolization of the gastric varices was performed with immediate reduction of blood flow in the varices (Figure 2). No procedure-related adverse events were noted. Repeat EGD and endoscopic ultrasound at 3 and 6 months showed obliteration and disappearance of gastric fundic varices (Figure 3). Patient remains asymptomatic with no evidence of recurrent gastrointestinal bleeding and no recurrence of gastric varices at 2-year follow-up.
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-Tarun Rustagi, MD
