Hiatal Hernia-Related Esophageal Varices Misdiagnosed as Cancer: Salvaged With Clipping

A 61-year-old man presented with hematemesis following a biopsy of a distal esophageal lesion initially suspected to be malignancy. Emergency endoscopy revealed tortuous submucosal vessels with active bleeding at the biopsy site. Band ligation failed due to poor suction, and hemostasis was successfully achieved using hemoclips. Imaging showed no evidence of cirrhosis or portal hypertension, but a large hiatal hernia compressing the distal esophagus was noted. At 2-week follow-up, 2 hemoclips placed at the biopsy site had detached spontaneously, and the patient remained stable without rebleeding. This case highlights an unusual presentation of esophageal varices caused by hiatal hernia, leading to cancer misdiagnosis and biopsy-induced hemorrhage. Endoscopic clipping served as an effective salvage technique after failed band ligation.