1036 Coils + Cyanoacrylate vs. Coils Alone in the Endoscopic Ultrasound-Guided Management of Gastric Varices [Gov Ii and Igv I]: A Randomized, Controlled Therapeutic Trial.

Robles-Medranda, Carlos; Valero, Manuel; ALcívar, Miguel Soria; Puga-Tejada, Miguel; Oleas, Roberto; Britto, Sylon R. De; Nebel, João Autran; Ospina, Jesenia; Alvarado, Haydee; Valle, Raquel S. Del; Lukashok, Hannah P.

doi:10.1016/j.gie.2018.04.1369

Cited by 3 publications

(6 citation statements)

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“…-Coil (2018) [31] Overall (I 2 =30.54%; P=0.015) Prior studies have demonstrated that EUS-guided therapy of GV is superior to direct endoscopic injection therapy. [28] However, few studies have evaluated the comparative efficacy and safety of the various EUS techniques.…”

Section: Discussionmentioning

confidence: 98%

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Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis

et al. 2020

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Cyanoacrylate (CYA), coil embolization, and/or combination thereof are available EUS-guided therapies for the treatment of gastric varices (GV). The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate the comparative effectiveness of EUS-guided interventions for the treatment of GV. Individualized search strategies were developed for PubMed, EMBASE, and Cochrane Library databases, from inception through November 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This cumulative meta-analysis was performed using calculating pooled proportions. Measured outcomes included technical success, clinical success, adverse events, and rate of rebleeding or reintervention. Comparative subgroup analyses were performed for three treatment cohorts (EUS-guided CYA injection, EUS-guided coil embolization + CYA injection, and EUS-guided coil injection alone). Heterogeneity was assessed with I 2 statistics. Eleven studies (n = 536 patients; 62.20% of males) were included. The mean age was 58.21 ± 4.15 years with an average follow-up of 12.93 ± 7.69 months. Overall technical success, clinical success, and adverse events for EUS treatments was 100% ([95% confidence interval [CI] 98-100]; I 2 = 30.54%), 97% ([95% CI 92-100]; I 2 = 59.99%), and 14% ([95% CI 6-23]; I 2 = 82.23%), respectively. On subgroup analysis, EUS-guided CYA + coil embolization resulted in a better technical and clinical success compared to CYA alone (100% vs. 97%; P < 0.001 and 98% vs. 96%; P < 0.001) and coil embolization alone (99% vs. 97%; P < 0.001 and 96% vs. 90%; P < 0.001). CYA + coil embolization also resulted in lower adverse event rates compared to CYA alone (10% vs. 21%; P < 0.001), and comparable rates to coil embolization alone (10% vs. 3%; P = 0.057). EUS-guided treatment overall appears to be an effective and safe modality for GV. Among a variety of EUS-therapies available, EUS combination therapy with coil embolization + CYA injection appears to be a preferred strategy for the treatment of GV over EUS-based monotherapy.

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Section: Discussionmentioning

confidence: 98%

“…Eleven studies (n = 536 patients) were included in this meta-analysis. [18,[25][26][27][28][29][30][31][32][33][34] A PRISMA flow chart of search results is shown in Figure 1. Two randomized controlled trials, one prospective study, and eight retrospective articles were included.…”

Section: Included Study and Patient Characteristicsmentioning

confidence: 99%

Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis

et al. 2020

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“…46 Lately, EUSguided deployment of coils in combination with cyanoacrylate injection has been demonstrated to reduce the risk of glue embolization 47,48 and can be superior to coil alone therapy. 49 For esophageal varices, one RCT showed EUS-guided sclerotherapy was as safe and effective as endoscopic sclerotherapy with no statistical difference in the amount of sclerosants and number of sessions to achieve eradication or recurrence of varices. 50 Although EUS is useful to evaluate periesophageal collateral or perforating veins, there are no data showing the necessity of EUS-guided intervention.…”

Section: Eus-guided Intervention For Portal Hypertensionmentioning

confidence: 99%

“…A multicenter trial comparing EUS‐guided coiling with EUS‐guided cyanoacrylate injection in 30 patients favored coiling because the risk of coil migration and pulmonary coil embolism was very low 46 . Lately, EUS‐guided deployment of coils in combination with cyanoacrylate injection has been demonstrated to reduce the risk of glue embolization 47,48 and can be superior to coil alone therapy 49 …”

Section: Eus‐guided Vascular Interventionmentioning

confidence: 99%

Endoscopic ultrasound guided hepatic interventions

Hashimoto

Chang

2020

Digestive Endoscopy

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Intervention for liver disease has predominantly been performed through the percutaneous approach. However, as endoscopic ultrasound (EUS) applications have expanded, there have emerged various EUS-guided interventions for liver disease, a space we call "Endo-Hepatology". EUS-guided liver biopsy can be considered the "forerunner" of Endo-Hepatology and has become a clinical option for patients requiring histologic diagnosis and staging of their liver disease. EUS also enables direct access to the portal vein. Subsequently, many procedures are being explored, such as angiography, measurement of the portosystemic pressure gradient, portal vein sampling to detect cancer cell or DNA, and EUS-guided transhepatic intrahepatic portosystemic shunt creation. Since the transducer is close to the liver, especially the left and caudate lobes, EUS can be used as a rescue when the percutaneous approach is not favorable and EUS-guided treatments of liver tumor, cyst and abscess have been reported. This review summarizes the available studies of EUS-guided intervention in the liver.

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“…In another recent randomized clinical trial from our group, we found that EUS-combined therapy was superior over EUS-coiling alone in terms of rebleeding and reintervention rates during follow-up. 29 Figure 2 summarizes the procedure steps for EUS-guided GVs obliteration, with the advantage of EUS-Doppler for flow and obliteration confirmation (Figure 1(b) and (e)).…”

Section: Eus-guided Glue and Coil Combination Therapymentioning

confidence: 99%

Insights into the role of endoscopic ultrasound–guided vascular therapy

Oleas

Robles-Medranda

2019

Clin Med Insights Gastroenterol

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Gastroesophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis and portal hypertension. The endoscopic injection of cyanoacrylate is considered as the first-line alternative for gastric varices treatment; however, the incidence of adverse events supports the endoscopic ultrasound–guided approach. Endoscopic ultrasound–guided interventions are a safe and feasible technique for the injection of sclerosants, cyanoacrylate, thrombin, and the deployment of coils into targeted vessels. This review article aims to offer an overview of the role of endoscopic ultrasound–guided vascular therapy and present the available data regarding endoscopic ultrasound–guided management of gastrointestinal bleeding and other vascular therapies. The available data have shown the superiority of endoscopic ultrasound–guided endovascular therapy over the endoscopic technique, which supports the implementation of endoscopic ultrasound–guided therapy in therapeutical algorithms and guidelines. Regarding whether injecting cyanoacrylate, the deployment of coils, or combined therapy, we recommend the endoscopic ultrasound–guided combined therapy in patients with gastric varices due to the high eradication rate with lower rebleeding and reintervention rates. Multicenter worldwide studies are required to confirm the actual clinical applicability of endoscopic ultrasound–guided endovascular therapy and establish treatment algorithms. Endoscopic ultrasound offered a safe and effective alternative in the management of variceal and nonvariceal gastrointestinal bleeding, with the implementation of new diagnostic and treatment options for various gastrointestinal conditions, representing a new territory for research and development.

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1036 Coils + Cyanoacrylate vs. Coils Alone in the Endoscopic Ultrasound-Guided Management of Gastric Varices [Gov Ii and Igv I]: A Randomized, Controlled Therapeutic Trial.

Cited by 3 publications

References 0 publications

Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis

Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis

Endoscopic ultrasound guided hepatic interventions

Insights into the role of endoscopic ultrasound–guided vascular therapy

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