An unusual cause of dysphagia after gastric variceal bleeding.

A 54-year-old male diagnosed with alcoholic cirrhosis had multiple episodes of upper gastrointestinal bleeding. He had a previous episode of hepatic encephalopathy. Baseline hepatic venous pressure gradient was 10 mmHg, and model for end-stage liver disease (MELD) score was 18. Gastroscopy revealed small low-risk esophageal varices (Figure 1a) and an active spurt from gastroesophageal varices type 2 (GOV2), which were successfully managed with intravenous terlipressin and intravariceal N-butyl cyanoacrylate injection (Figure 1b). Contrast-enhanced computed tomography (CECT) of the abdomen revealed a large tortuous gastrorenal shunt that formed multiple gastric varices at the cardia and fundus of the stomach (Figure 1c, arrows). Balloon-occluded retrograde transvenous obliteration (BRTO) of the gastrorenal shunt was performed, and follow-up abdomen CECT revealed lipiodol retention with thrombosis of the gastric varices (Figure 1d, arrow). After 2 months, he was again admitted owing to hematemesis, and gastroscopy revealed large esophageal varices and obturated GOV2 (Figure 1e). Hemostasis was achieved by esophageal band ligation (EBL) of the large esophageal varices. After 3 months, he was evaluated for progressive dysphagia and weight loss. Turk J Gastroenterol 2017