Two cases of successful treatment of bleeding esophagojejunal varices after total gastrectomy using reopenable clip hemostasis.

Esophagojejunal variceal bleeding after total gastrectomy is rare but potentially life-threatening, and no standard treatment has been established. Endoscopic variceal ligation (EVL) may be technically difficult for postoperative anastomotic lesions because of fibrosis. We report two cases of ruptured esophagojejunal anastomotic varices after total gastrectomy, for which hemostasis was successful with reopenable through-the-scope clips after failed EVL. Case 1 involved a 66-year-old man with metabolic dysfunction-associated steatohepatitis-related cirrhosis and history of total gastrectomy presenting with melena and hematemesis. Emergency endoscopy revealed bleeding from a jejunal anastomotic varix. EVL failed because of severe fibrosis, but hemostasis was achieved using reopenable clips. Subsequent endoscopic injection sclerotherapy confirmed blood flow interruption at the clip sites, with no rebleeding during the 2-year follow-up. Case 2 involved a 70-year-old man with alcohol-related cirrhosis and history of total gastrectomy who presented with hematemesis. Emergency endoscopy revealed active bleeding from the esophageal-side anastomotic varix. EVL failed because of fibrosis, but hemostasis was successful with four reopenable clips. No rebleeding was observed during the 4-month follow-up. Reopenable clips may represent a practical therapeutic option for bleeding esophagojejunal anastomotic varices with severe fibrosis when conventional EVL is technically difficult or unsuccessful.