PTU-65 Cyanoacrylate-injection endotherapy facilitated by double-balloon enteroscopy: endoscopic management of anastomotic varices bleeding

IntroductionSmall bowel varices are an uncommon cause of severe gastrointestinal bleeding. There is no consensus regarding the endoscopic management of these patients. Cyanoacrylate injection endotherapy has been described as a therapeutic alternative in some cases.MethodsA 65-year-old man with a metastatic mid-gut neuroendocrine tumour warranting extensive small-bowel resection presented with life-threatening mid-gut bleeding. A CT enterography (CTE) demonstrated jejunal anastomotic varices, with superior mesenteric vein thrombosis. Without a radiological option for treatment, anterograde double-balloon enteroscopy (DBE) was planned to facilitate cyanoacrylate-injection endotherapy (CIE).ResultsDuring DBE 2 nests of bleeding varices were identified at the anastomosis. DBE CIE (diluted in lipiodol) was successful performed through a wide-bore injection-needle. No immediate or delayed adverse events were reported. A subsequent CTE confirmed successful embolisation of the mid-gut varices. The patient has not bled further during 6-months of follow-up.ConclusionsDBE facilitated CIE of mid-gut varices is effective and safe in carefully selected cases.