Udupi: Doctors at Kasturba Hospital, Manipal, successfully treated a 60-year-old man suffering from life-threatening gastrointestinal bleeding caused by chronic liver disease without the need for surgery, using advanced endoscopy and interventional radiology techniques.The patient was admitted after vomiting blood and was diagnosed with gastrointestinal bleeding due to a bleeding fundal varix, a condition caused by portal hypertension associated with chronic liver disease. Such bleeding carries a high risk of mortality if not treated promptly.An emergency upper gastrointestinal endoscopy performed by Dr Shiran Shetty, gastroenterologist, revealed a fundal large varices in the upper part of the stomach. The team controlled the bleeding using endoscopic ultrasound (EUS)-guided therapy, a minimally invasive procedure that enabled doctors to precisely identify and treat the bleeding blood vessel.“Endoscopy today is not merely for making a diagnosis. The ultrasound at the tip of the scope allowed us to identify the exact vessel that had ruptured and treat it precisely when the patient was critically ill. Controlling the bleeding quickly gives us the opportunity to plan a long-term solution rather than repeatedly managing emergencies,” Dr Shetty said.Further evaluation showed that the patient had developed a gastrorenal shunt, an abnormal connection between the portal circulation and the left renal vein, which was continuously feeding the gastric varices. Following a multidisciplinary discussion, the patient underwent plug-assisted retrograde transvenous obliteration (PARTO), a procedure performed by the interventional radiology team led by Harshith K.A post-procedure CT scan confirmed complete closure of the shunt. The patient experienced no further bleeding and was discharged within 48 hours. A follow-up endoscopy confirmed that the gastric varices had been successfully obliterated.
