A Case of Portal Hypertensive Gastropathy Treated by Embolization of the Left Gastric Artery

A 65-year-old female with hepatitis C virus antibody positive liver cirrhosis was admitted to our hospital with hematoemesis in January 1993. Sclerotherapy and ligation using clipping apparatus for esophageal varices had performed 4 months before the admission. The gastrointestinal endoscopy revealed mosaic pattern (snake skin pattern) and multiple red spots with hemorrhage in upper corpus. Biopsy specimen obtained by endoscopy showed erosion and dilated capillaries contained erythrocytes in the superficial mucosa. Definite portal hypertension and none of large drainage vein from left gastric vein were confirmed by percutaneous transhepatic portography and left gastric arteriography respectively. These findings above revealed that portal hypertensive gastropathy resulted in the congestion of gastric vein. Propranolol was not efficacious against these gastric mucosal damages. Embolization of the left gastric artery was undertaken to decrease gastric mucosal blood flow. No mucosal hemorrhage was recognized endoscopically next day. Further more endoscopy 2 months after the embolization revealed that these gastric mucosal changes were almost disappeared and that gastric varices was appeared on the other hand, which seemed like to reduce the congestion of gastric veins. Therefore it was suggested that embolization of the left gastric artery is safety and effective on acute gastric mucosal hemorrhage at least with portal hypertensive gastropathy.