A 73-year-old woman with a history of portal hypertension secondary to mixed primary biliary and alcoholic cirrhosis presented with multiple episodes of hematemesis. In the emergency department, she was hemodynamically stable with a hemoglobin of 10 mg/dL. She was started on proton pump inhibitor and octreotide infusions with the plan to perform esophagogastroduodenoscopy (EGD). The EGD was carried out under monitored anesthesia care with intravenous propofol without an airway, using room air for insufflation. This revealed Grade III esophageal varices with active bleeding in the lower third of the esophagus (Figure ). Three bands were placed, resulting in deflation of varices and cessation of bleeding (Figure ). No evidence of ulceration or erosion was found in the stomach or duodenum, and no intraoperative complications were noted. The patient's vital signs were stable throughout the procedure. Electrocardiogram showed normal sinus rhythm.
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