EUS-Assisted Evaluation of Rectal Varices before Banding

Figure 4

(a) An ulcer covered by a clot gives appearance of Dieaulafoy’s ulcer. Clot could not be removed by flushing. (b) At about 6 cm distance in rectum inflowing perforators were noted in the submucosa of rectum. No pararectal varices were seen. (c) A band is applied on the clot as rectal varices were demonstrated by EUS under the ulcer. (d) The bleed stopped but after 24 hours patient rebleeds from a fresh point above the previously banded ulcer. (e) The new point of bleeding is caught inside the band. (f) Two bands are seen applied separately. (g) An inflowing perforator of the diameter of 3 mm is seen coming from the lateral wall of rectum before banding. (h) The diameter of rectal varices became smaller and more numerous as they were followed downwards the anorectal junction. At 4 cm distance the rectal varices are seen going towards the prostate.