内镜下食管静脉曲张出血和止血夹喷雾

                               
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A 49 year old man with a history of alcoholic liver disease was admitted with haematemesis (the admitting doctor witnessed ‘half a bowl ful’). A month earlier, he was diagnosed with a pulmonary embolus and commenced on warfarin. Unfortunately, he continued to drink up to 3L of strong cider /day. On admission, investigation results were: Hb 11.9 g/dl (usually 14g/dl), INR 2.5 (pre warfarin INR was 1.5), Bilirubin 60 umol/L, Albumin 32. The warfarin was reversed with Beriplex (prothrombin complex concentrate) and after fluid resuscitation, an urgent out of hours OGD was performed… endotherapy was a little unorthodox (see video).