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A 65-year-old man (an alcoholic and a smoker) presented with recurrent abdominal pain,
weight loss, and loss of appetite. He was known to have had chronic calcific pancreatitis
since 2014. CT of the abdomen showed a 3.6 × 3.4 cm mass in the head of the pancreas,
with calcification in the head and body (Fig. 1). An EUS-guided fine needle aspiration of pancreatic head mass (FNAC) revealed a
neuroendocrine tumor of the pancreatic head. EUS also showed prominent collaterals
adjacent to the mass. One week later, he was admitted with massive GI bleeding. Endoscopy
showed active bleeding from the second part of the duodenum. Hemostasis was achieved
with hemoclips. Rebleeding occurred after 6 hours. Repeated endoscopy showed bleeding
from the same site. EUS showed actively bleeding collaterals at the pancreatic head
mass. Doppler showed high-velocity flow. EUS-guided placement of coils was planned.
Using a 19G needle, we placed 3 coils because the vessel was large (Video 1, available online at www.giejournal.org). Complete thrombosis of the vessel was confirmed by color Doppler. Surgery could
not be done because of the patient’s high-risk comorbid conditions, eg, severe coronary
and pulmonary disease. He has not experienced rebleeding and has been followed up
for 180 days. EUS-guided placement of coils is an effective treatment for the management
of bleeding duodenal varix.
