Objective To investigate the safety and efficacy of endoscopic tissue adhesive injection combined with sequential endoscopic variceal ligation for gastroesophageal varices of Le,g type. Methods Twenty-three patients with gastroesophageal varices of Le,g type were enrolled to General Hospital of PLA from May 2013 to March 2015, who were treated with endoscopic tissue adhesive injection in the fundic and cardiac site in the first session, followed with endoscopic variceal ligation for esophageal varices. The clinical data, procedure complications and efficacy were retrospectively analysed. Results All procedures were successfully performed with no such evident complications as intraoperative and postoperative bleeding, embolization, mediastinal infection or death with an average hospitalization time of 15. 3±4. 09 days. Mild and moderate thoracalgia occurred in 13 patients(56. 5%), low-grade fever in 2 patients(8. 7%, recovered after symptomatic treatment for 1-2 days) . During the follow-up of 2 weeks, the rate of varices disappearance was 56. 5% (13/23) and no recurrent bleeding was observed. Six months after discharge, 10 patients underwent endoscopy again, varices disappeared in 4 and 6 with remains;the 13 others showed no hemorrhage according to follow-up call. Conclusion The therapy of endoscopic tissue adhesive injection with sequential endoscopic variceal ligation for gastroesophageal varices of Le,g type is safe and efficient.

Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.