Endoscopy 2020; 52(01): 81
DOI: 10.1055/a-1021-8805
Letter to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Reply to Chaudhari

Mingyan Zhang
Shandong Provincial Hospital affiliated to Shandong University
,
Chunqing Zhang
Shandong Provincial Hospital affiliated to Shandong University
› Author Affiliations
Further Information

Publication History

Publication Date:
18 December 2019 (online)

We would like to thank Chaudhari et al. for their interest in our paper [1] and for taking the time to express their concerns.

Acute gastrointestinal bleeding occurred in only four patients, therefore, yielding a hemostasis rate of 100 %. To evaluate the efficiency of hemostasis, more patients with acute gastrointestinal bleeding are needed.

For patients without large gastrorenal shunts, the possibility of ectopic embolization is small, hence direct endoscopic cyanoacrylate injection can be performed. For patients with large gastrorenal shunts, however, lethal ectopic embolization may occur and clips were therefore used to restrict the blood flow and reduce the incidence of ectopic embolization.

Eradication was defined as no varices within the stomach on contrast-enhanced computed tomography (CT). Varices and large folds of mucous membrane are sometimes difficult to distinguish with endoscopy. We used contrast-enhanced CT for reference; CT has shown high accuracy for the diagnosis of varices in liver cirrhosis [2] [3]. For all patients, repeat endoscopic injection was required unless there were no macroscopic gastric varices.

We have no statistical data for factors predictive of reintervention. However, from our own experience, reintervention is usually needed in patients with more tributaries; further study is warranted.

The gastrorenal shunt maintained reserve in the four cases of exacerbation of esophageal varices. The embolization was restricted to the gastric varices, and the gastrorenal shunt was not embolized during the procedure. Exacerbation of esophageal varices may be the result of increased portal hypertension.

Routine antibiotics were used after the procedure. One patient was diagnosed with bacteremia. The majority of patients with fever had mild symptoms and did not undergo blood culture.