A 74-year-old man with compensated hepatitis C virus-related
liver cirrhosis was admitted for the treatment of small
hepatocellular carcinoma (HCC) by
radiofrequency ablation therapy (RFA). As a routine pretreatment examination, gastrointestinal endoscopy was performed, and large nodular
varices were observed in the gastric fornix, with
telangiectasia on top of the
varices. As soon as the RFA was completed, prophylactic balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. Seven days after the B-RTO, the patient complicated of upper
abdominal pain. Gastrointestinal endoscopy was performed, and a deep
ulcer, located at the top of the
tumor-shaped
gastric varices, was found. The
ulcer showed rapid healing after 1-week administration of a
proton pump inhibitor (PPI). A severe
ulcer after a B-RTO procedure, is extremely rare, because
sclerosing agents rarely flow into the gastric mucosa. The
ulcer in this patient was deep and large, and it may have been due to direct mucosal damage caused by the
sclerosing agent, because mucosal
telangiectasia on top of the
varices was observed before the B-RTO. It is likely that, in this patient, the mucosal vessels communicated with the submucosal large
varices, and
ethanolamine oleate (EOI) flowed into the gastric mucosa via this communication. Based on our experience, we recommend periodic follow-up endoscopy.