LAUSR

A 54-year-old man with hepatitis C and alcohol-related Child–Pugh C cirrhosis had refractory ascites. He underwent band ligation of large esophageal varices because of his intolerance of beta blockers. Four bleeding episodes from ligation-induced ulcers occurred and an SXElla Danis fully covered self-expanding metal stent (SEMS) was placed during the last of these episodes (▶Fig. 1 and ▶Fig. 2). On endoscopic evaluation, the distal end of the stent was proximal to the gastroesophageal junction and there was major bleeding occurring in the distal, non-covered esophagus (▶Fig. 3 a) but, after sclerosant injection, the flow of blood diminished. The retrieval stent loop was grasped, which allowed slight constriction and distal movement of the stent, which resulted in adequate coverage of the distal esophagus and control of the bleeding (▶Fig. 3b; ▶Video 1). The stent was later removed after a transjugular intrahepatic portosystemic shunt (TIPS) had been placed. Refractory esophageal variceal bleeding can be addressed by balloon tamponade, insertion of a SEMS, and/or a rescue TIPS. SEMSs are considered efficacious in this setting, usually allowing more time in place with fewer adverse events when compared with balloon tamponade [1– 3]. We re-evaluated this adverse event and found two possible explanations. One was related to the fact that the dedicated balloon was inflated with 100mL of air, according to the manufacturer instructions provided. After further investigation, we encountered an alternative E-Videos