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Intraductal papillary mucinous neoplasm — ESEGH MCQ

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HardGI CancerIntraductal papillary mucinous neoplasmESEGH

Urgent endoscopy in a cirrhotic patient shows active bleeding from an isolated fundal gastric varix. Terlipressin and prophylactic antibiotics are running, and the patient is stable enough for endoscopic haemostasis. Which initial endoscopic treatment does NICE recommend?

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Correct answer: D — Endoscopic N-butyl-2-cyanoacrylate injection into the varix

Option D is correct because NICE recommends N-butyl-2-cyanoacrylate injection as initial endoscopic haemostasis for bleeding gastric varices. Option E is preferred for oesophageal rather than fundal gastric varices. Option B is a non-variceal-ulcer technique. Option A is unsuitable for a high-flow submucosal varix. Option C is used if cyanoacrylate does not control gastric-variceal bleeding rather than before the recommended endoscopic attempt.

Reference: NICE CG141: acute upper gastrointestinal bleeding. https://www.nice.org.uk/guidance/cg141/chapter/Recommendations