Management of variceal bleeding in pregnancy with endoscopic variceal ligation and N-butyl-2-cyanoacrylate: report of three cases

Abstract

Radha K. Dhiman, MD, DM, Rakesh Biswas, MD, Neelam Aggarwal, MD, Harjit Sawhney, MD, Yogesh Chawla, MD, DM Pregnancy is relatively uncommon in women with portal hypertension.1 Reports of pregnancy and successful delivery in patients with portal hypertension are few.2,3 There are a few reports of successful endoscopic sclerotherapy (EST) for variceal bleeding in pregnant women.4,5 Endoscopic variceal ligation (EVL), first reported by Steigmann et al.,6 has rapidly emerged as the treatment of choice for prevention of recurrent variceal esophageal bleeding.7 Gastric (fundal) varices pose a risk of bleeding,8 which can be successfully controlled with injection of n-butyl2-cyanoacrylate.9,10 We report three cases of pregnant women with portal hypertension and bleeding varices who were successfully treated endoscopically. One had cirrhosis and From the Departments of Hepatology and Obstetrics and Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.