Clinical presentation

A 67-year-old man presented to our centre 5 years ago with a short history of jaundice and weight loss. A diagnosis of autoimmune hepatitis was made following laboratory investigations, imaging and a trans-jugular liver (TJ) biopsy. He was treated with prednisolone and azathioprine, which resulted in normalisation of his transaminases and bilirubin. Four years later, he was diagnosed with cirrhosis (Childs class A) based on clinical, biochemical and radiological parameters. He underwent a screening endoscopy, which revealed grade III oesophageal varices with multiple red signs and was started on propranolol as primary prophylaxis. He was unable to tolerate β blockers and oesophageal endoscopic band ligation (EBL) was subsequently undertaken. He underwent six further upper GI endoscopies with repeated EBL of his oesophageal varices; however, the grade III varices with red signs …