Published online Dec 25, 2015. doi: 10.4253/wjge.v7.i19.1350
Peer-review started: April 8, 2015
First decision: May 14, 2015
Revised: June 30, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: December 25, 2015
Processing time: 260 Days and 3.1 Hours
Endoscoic variceal ligation (EVL) by the application of bands on small bowel varices is a relatively rare procedure in gastroenterology and hepatology. There are no previously reported paediatric cases of EVL for jejunal varices. We report a case of an eight-year-old male patient with a complex surgical background leading to jejunal varices and short bowel syndrome, presenting with obscure but profound acute gastrointestinal bleeding. Wireless capsule endoscopy and double balloon enteroscopy (DBE) confirmed jejunal varices as the source of bleeding. The commercially available variceal banding devices are not long enough to be used either with DBE or with push enteroscopes. With the use of an operating gastroscope, four bands were placed successfully on the afferent and efferent ends of the leads of the 2 of the varices. Initial hemostasis was achieved with obliteration of the varices after three separate applications. This case illustrates the feasibility of achieving initial hemostasis in the pediatric population.
Core tip: Banding jejunal varices in the pediatric population is feasible, safe and can achieve initial hemostasis in complex surgical patients.