The Value of Endoscopic Color Doppler Ultrasonography for Detection of the Bleeding Site of Gastric Varices Secondary to Splenic Occlusion

A 71-year-old woman was admitted to our hospital for treatment of cancer in the body and tail of the pancreas. After admission, she had tarry stool and esophagogastroduodenoscopy (EGD) was performed. EGD revealed enlarged tortuous, red color sign negative gastric varices between the cardiac orifice, fundus and the curvature ventriculi major of the gastric body. Computed tomography showed gastric varices due to splenic vein occlusion with advanced pancreatic cancer (left-sided portal hypertension). However, endoscopic observation was not sufficient to identify the bleeding site of the gastric varices. Consecutively, endoscopic color Doppler ultrasonography (ECDUS) was performed to evaluate the gastric varices in detail. ECDUS showed the velocity of gastric varices in the cardiac orifice and fundus to be 11.7 cm/sec, the thickness of the gastric wall to the submucosal gastric varices being 1.0 mm, and the gastric varices in the cardiac orifice and fundus were diagnosed as the likely bleeding site. Subsequently, we performed endoscopic obliterative therapy with 70% n-butyl-2- cyanoacrylate diluted with 5% Lipiodol at the possible bleeding site of these varices. The patient experienced no further episodes of bleeding during the three months following treatment.