Uncoiling the Coil: Coil Extrusion After Coil Assisted Retrograde Transvenous Obliteration for Gastric Variceal Bleeding.
Sumeet K. Asrani M.D.
Soape, M. P., A. Lichliter and S. K. Asrani (2018). “Uncoiling the Coil: Coil Extrusion After Coil Assisted Retrograde Transvenous Obliteration for Gastric Variceal Bleeding.” Clin Gastroenterol Hepatol 16(5): e59.
An 83-year-old woman with cryptogenic cirrhosis (Model for End-stage Liver Disease score, 7) presented with melena 7 months after successful coil-assisted retrograde transvenous obliteration treatment of hemodynamically unstable bleeding gastric varices. Previously, embolization of the gastrorenal shunt and bleeding gastric varices was successful with 3% sotradecol, lipiodol, and terlock-35 fibered detachable coils (Boston Scientific, Marlborough, MA) and Azur detachable coils (Terumo, Tokyo, Japan). During her current hospitalization, she underwent standard medical management for suspected variceal bleeding. Endoscopy showed an embolization coil extruding through a decompressed gastric varix with mild intermittent oozing. Computed tomography of the abdomen confirmed migration of a coil into the stomach. The intraluminal coil was not removed given concerns for worsening of the bleed. The patient was managed conservatively for 72 hours. She was discharged home and seen 1 month later as an outpatient in good health with no reported melena. The complication rate of balloon-occluded retrograde transvenous obliteration is less than 5% and primarily includes thromboembolic events with complications relatively unknown with its modified version of coil-assisted retrograde transvenous obliteration. This endoscopic finding likely will increase in prevalence with the expansive use of coiling for acute gastric variceal hemorrhage given fewer contraindications compared with transjugular intrahepatic portosystemic shunt creation. (Excerpt from text, p. e59; no abstract available.)