P0951 - Rare Case of Non-Cirrhotic Isolated Gastric Varices Due to Complex Pancreatic Cyst Compressing Splenic Vein

Hannah Eom, BA¹, Vishnu Yanamaladoddi, MD¹, Amla Patel, MBBS², Vikash Kumar, MD¹, Aida Rezaie, MD¹
1Creighton University School of Medicine, Phoenix, AZ; 2Creighton University, Phoenix, Phoenix, AZ

Introduction: Non-cirrhotic isolated gastric varices (IGV) are rare and typically linked to isolated left-sided portal hypertension (LSPH), often caused by splenic vein thrombosis or compression. This is commonly due to pancreatic conditions such as pancreatitis, neoplasms, or cysts. IGV without esophageal involvement is especially uncommon. Although early recognition of high-risk bleeding is emphasized, standardized management for LSPH-related varices remains unclear. We present a case of IGV from splenic vein compression by complex pancreatic cysts, emphasizing the need for cohesive methodology and definitive interventions like splenectomy or IR-guided drainage in select patients.

Case Description/

Methods: 53-year-old man with a history of alcohol abuse and prior alcoholic pancreatitis presented with hematemesis. He reported to melena for one week prior to arrival. He denied NSAID, antiplatelet, or anticoagulant use. Vitals were stable. Labs showed hemoglobin 4.5 g/dL, MCV 68 fL, and platelets 127,000/µL. He was treated with blood transfusions and IV proton pump inhibitors. MRI abdomen revealed fundal gastric bleed and a complex cystic mass in the pancreatic tail and splenic hilum with internal hemorrhage, causing localized pressure and IGV. No evidence of cirrhosis or splenorenal shunt was seen. EGD showed large IGV with high-risk stigmata and no esophageal varices. Bleeding was controlled with N-butyl-2-cyanoacrylate and Lipiodol injection. The patient improved clinically. Given the high risk of rebleeding from the gastric varices and persistence of a cystic lesion with internal hemorrhagic content, the case was reviewed with IR. BRTO and TIPS were deemed unsuitable due to absence of splenorenal shunt and lack of generalized portal HTN. The management plan included endoscopic ultrasound to reassess the varices and determine the need for repeat endoscopic glue injection, along with follow-up imaging in 4–6 weeks to evaluate for IR-guided drainage of the pancreatic cyst.

Discussion: This case highlights the diagnostic and therapeutic challenges of IGV due to LSPH from splenic vein compression by pancreatic cysts. In the absence of cirrhosis, IGV may be overlooked, delaying life-saving intervention. Early recognition and multidisciplinary management are critical, especially with high-risk variceal bleeding. Structured follow-up with imaging and endoscopy, and consideration of definitive interventions such as IR-guided drainage or splenectomy are essential.

Disclosures:
Hannah Eom indicated no relevant financial relationships.
Vishnu Yanamaladoddi indicated no relevant financial relationships.
Amla Patel indicated no relevant financial relationships.
Vikash Kumar indicated no relevant financial relationships.
Aida Rezaie indicated no relevant financial relationships.

Hannah Eom, BA¹, Vishnu Yanamaladoddi, MD¹, Amla Patel, MBBS², Vikash Kumar, MD¹, Aida Rezaie, MD¹. P0951 - Rare Case of Non-Cirrhotic Isolated Gastric Varices Due to Complex Pancreatic Cyst Compressing Splenic Vein, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.