1. Recurrent Upper Gastrointestinal Bleeding from Isolated Gastric Varices as Primary Symptom of Myelofibrosis: A Case Report on Combining Interventional and Pharmacologic Treatment Options.
- Author
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Giszas B, Weber M, Heidel FH, and Reuken PA
- Subjects
- Adult, Cyanoacrylates, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Humans, Esophageal and Gastric Varices diagnostic imaging, Esophageal and Gastric Varices etiology, Esophageal and Gastric Varices therapy, Hypertension, Portal complications, Primary Myelofibrosis complications, Primary Myelofibrosis therapy
- Abstract
Portal hypertension leads to pronounced venous collateralization and development of varices. Besides manifest liver cirrhosis, primarily left-sided portal hypertension is causal for the development of gastric varices. We present a case of a 36-year-old female patient with splenomegaly, underlying primary myelofibrosis, and detection of somatic Janus-kinase-2 driver-mutation JAK2V617F. Following first upper gastrointestinal bleeding, isolated gastric varices could be detected as a result of underlying left-sided portal hypertension. Within a few months, repeated life-threatening bleedings with transfusion requirements and frequent hospitalizations occurred. Despite multiple injections of cyanoacrylates, the proven therapy of choice, varices could not be stabilized. Combination of targeted JAK-inhibitor therapy in conjunction with the use of EUS-guided application of coils with subsequent cyanoacrylate injection resulted in acute and long-term bleeding control., (© 2021 S. Karger AG, Basel.)
- Published
- 2022
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