Abstract
Autoimmune pancreatitis is a rare type of chronic pancreatitis associated with immune disorders. Co-occurrence of regional portal hypertension and gastric variceal bleeding associated with autoimmune pancreatitis is exceedingly rare. This case report aimed to highlight the dual role of endoscopic ultrasonography in the diagnosis and treatment of this condition and discuss the choice of medication for inducing remission. A 44-year-old man presented with melena and anemia. Imaging revealed pancreatic swelling, splenic vein occlusion, and gastric varices. Endoscopic ultrasonography-guided fine-needle biopsy confirmed autoimmune pancreatitis. Endoscopic ultrasonography was used to successfully manage gastric variceal bleeding via coil placement and tissue glue injection. The patient was treated with rituximab, resulting in improved hemoglobin levels, reduced B lymphocyte count, and resolution of pancreatic swelling. Follow-up indicated successful management and patient well-being. Additionally, we reviewed published cases of autoimmune pancreatitis patients with portal hypertension. In conclusion, endoscopic ultrasonography plays a crucial role in the diagnosis and treatment of autoimmune pancreatitis complicated by gastric variceal bleeding. Rituximab may be more effective than glucocorticoids in treating autoimmune pancreatitis associated with gastric variceal bleeding.