Recurrent Bleeder in a Liver Disease, Managed with Anterograde Transvenous Obliteration

We present a case of upper gastrointestinal (UGI) bleeding in a middle-aged gentleman with cryptogenic liver cirrhosis. Initial assessment showed well-preserved liver function. Endoscopy showed Grade II esophageal varices with red signs. He underwent conventional endoscopic variceal ligation (EVL) therapy for the same. He was banded twice because of the recurrent UGI bleed. His general condition worsened after the recurrent bleed. He had not responded to the standard of care with beta-blockers and EVL therapy. He decompensated swiftly in a short span of time. He was planned for for rescue transjugular intrahepatic portosystemic shunt (TIPS) during the stay. He underwent TIPS with adjunctive trans-TIPS anterograde transvenous obliteration. Postprocedure, he was stabilised, and bleeding was controlled. He developed 2 episodes of Grade 3 hepatic encephalopathy, which was conservatively managed. He is on current follow-up for 24 months without any further bleeding episodes.