The role of TIPS in managing variceal hemorrhage and esophageal stenosis: a strategic shift.

We present the case of a 71-year-old male with compensated liver cirrhosis evaluated abroad for severe gastrointestinal bleeding secondary to esophageal varices treated with n-butyl-cyanoacrylate injection; as a complication, the patient presents with dysphagia and retrosternal discomfort. Follow-up gastroscopy revealed esophageal varices (EV) with high-risk stigmata and a fibrous esophageal stricture secondary to the previous sclerotherapy. This stenosis prevented the passage of the endoscopic band ligation kit, making standard secondary prophylaxis impossible. Given the risk of rebleeding and the technical difficulty of endoscopic treatment, the placement of a transjugular intrahepatic portosystemic shunt (TIPS) was decided. "In the present case, the esophageal stenosis secondary to sclerotherapy posed a therapeutic challenge by limiting the use of the ligation kit, thus compromising standard secondary prophylaxis. TTIPS placement should be considered as an option in cases of conventional endoscopic therapy failure or when technical complications prevent its implementation.