#challenge case

A 59-year-old man presented with recurrent attacks of hematemesis and melena and was admitted to the hospital. The patient gives a history of band ligation for esophageal varices and liver cirrhosis. The patient was admitted to the hospital and received resuscitation and a blood transfusion. The platelet count is . Hemoglobin level is 7.7 gm/dl. Albumin was 2.5. serum creatinine is 1.5 mg/dl/. the international normalized ratio was . questions: what about the decision of upper GI endoscopy in this patient with prolonged INR, elevated creatinine level, and severe thrombocytopenia? What is the cause of active bleeding after an injection? 1- the amount of amacrylate is small in comparison to the size of varix 2- the patient’s low platelet count and prolonged INR 3- high portal hypertension 4- the tip of the injector puts extra pressure on the varix What are your lines of treatment? 1- Conservative treatment 2- Reinjection with amacrylate 3- Clips 4- Eus guided injection