Supplementary Material for: Management of Refractory Esophageal Variceal Bleeding When TIPSS Is Not Possible: Review of a challenging case

Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination of antimicrobial therapy prior to endoscopic variceal ligation (EVL). In cases of refractory EVB, trans-jugular intrahepatic portosystemic shunt (TIPSS) is recommended, however, it is contraindicated in up to 35% of cases. We report a case of 61-year-old-male newly diagnosed with hepatocellular carcinoma and extensive portal vein thrombosis. The patient developed a refractory EVB failing medical and endoscopic therapies which was successfully treated with transcutaneous left gastric vein embolization. LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise.

食管静脉曲张出血（Esophageal variceal bleeding, EVB）是门静脉高压的常见并发症。临床指南推荐在实施内镜下静脉曲张套扎术（endoscopic variceal ligation, EVL）前，联合应用血管活性药物与抗菌药物治疗。对于难治性EVB，临床推荐行经颈静脉肝内门体分流术（trans-jugular intrahepatic portosystemic shunt, TIPSS），但该术式在多达35%的病例中存在禁忌证。本文报告1例新诊断为肝细胞癌并伴广泛门静脉血栓形成的61岁男性患者，其在接受药物及内镜治疗后仍出现难治性EVB，最终通过经皮胃左静脉栓塞术（transcutaneous left gastric vein embolization, LGVE）成功止血。当存在解剖复杂性或TIPSS禁忌证时，可考虑采用LGVE治疗。