Document Type

Case Report


Digestive System Diseases | Pathological Conditions, Signs and Symptoms


Background: Over 600,000 people in the United States (U.S.) have liver cirrhosis. It is estimated that 30% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis will develop varices in their lifetime, with an incidence rate of new varices at 9% per year. Fifty percent of patients with esophageal varices will experience bleeding at some time. Pheochromocytoma is a rare catecholamine secreting adrenal gland tumor that occurs in 2-8 people per every 1 million people in the general population. Standard treatment for variceal bleeding includes endoscopic band ligation and/or radiologic embolization along with non-selective beta blockers. However, the use of non-selective beta blockers in patients with untreated pheochromocytoma could lead to unopposed alpha receptor stimulation and subsequent risk of life-threatening hemodynamic instability.

Case: A 69-year-old male presented with hematemesis and melena. Emergent upper endoscopy showed bleeding esophageal varices. Band ligation resulted in successful hemostasis. Prior to initiating non-selective beta-blockade (NSBB) for secondary variceal bleeding prophylaxis, he was given doxazosin to minimize unopposed alpha-stimulation.

Conclusion: Variceal bleeding with untreated pheochromocytoma can be safely managed endoscopically and/or radiologically under anesthesia. Providers should administer alpha-blockade in the periprocedural period and prior to initiation of non-selective beta blockers for secondary varices prophylaxis to avoid unopposed alpha receptor stimulation from PCC-related catecholamine secretion.




hepatocellular carcinoma, portal vein tumor thrombus, esophageal varices, gastrointestinal bleed, pheochromocytoma, periprocedural management

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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