Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue

Iwase, Hiroaki; Suga, S; Morise, Kimitomo; Kuroiwa, Atsuo; Yamaguchi, Takeo; Horiuchi, Yoh

doi:10.1016/s0016-5107(05)80599-1

Cited by 91 publications

(56 citation statements)

References 12 publications

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“…Iwase et al showed that the feeding vein for the junctional type of GV was mainly the left gastric vein, whereas the fundal type of GV was fed by short gastric veins. 5 Varices of the gastroepiploic vein are rare but often occur after the treatment of other GV with surgery or coil embolization.…”

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confidence: 99%

Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

Bhatia

2012

Journal of Clinical and Experimental Hepatology

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Gastric varices (GV) have three major inflow tracts: (1) left gastric or coronary vein, (2) short gastric veins, and (3) posterior gastric veins. Most GV are formed by the left gastric or posterior gastric vein. 1,2The left gastric or coronary vein decompresses the portal vein directly via hepatofugal blood flow. Gastric varices of the left gastric vein are frequently located at the cardia and sometime extend cephalad to coalesce with the (para)esophageal varices.3 Hashizume et al showed that the anterior branch of the left gastric vein forms the gastroesophageal varices by directly communicating with the submucosal veins, while the posterior branch extends along the outside of the esophageal wall across the esophagogastric junction to drain into the para-esophageal collateral channels. 4 The other major inflow route is via the short gastric veins, which decompress the splenic vein at the splenic hilum ( Figure 1). Gastric varices of the posterior gastric and short gastric veins are frequently located at the fundus and drain into a major porto-systemic shunt. Iwase et al showed that the feeding vein for the junctional type of GV was mainly the left gastric vein, whereas the fundal type of GV was fed by short gastric veins.5 Varices of the gastroepiploic vein are rare but often occur after the treatment of other GV with surgery or coil embolization.The efferent tract of the GV can be upwards into the azygos system, or into one of the major porto-systemic shunt. The majority of varices located at the gastric fundus drain into the inferior phrenic vein, which later joins with the left renal vein to form the gastrorenal shunt (80-85% of cases) or with the inferior vena cava just below A large part of portal venous system and the paragastric and para-esophageal collateral circulation is within the reach of endoscopic ultrasound (EUS). The EUS is more sensitive than gastroscopy for the detection of gastric varices (GV), and can accurately distinguish GV from thickened gastric folds. Gastric varices are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger collateral channels visible outside the gastric wall. The EUS has also been used to monitor the completeness of GV obturation after glue injection. There are limited data that this strategy may be clinically beneficial to prevent GV re-bleed. The EUS has been used to deliver glue injections under real-time monitoring into the vascular channels, with or without steel coils as scaffolding for the glue. The potential advantages of this technique include a straight scope position, lack of hindrance from pooled blood in gastric fundus, smaller glue volume requirements, and precise intra-vascular placement of glue with avoidance of intramural injections, and reduced embolic complications. (J CLIN EXP HEPATOL 2012;2:70-74) Figure 1 Serpiginous anechoic elongated vascular channels along the upper splenic pole at the gastroesophageal junction and gastric fundus (arrow), suggestive of short gastric vein collaterals (arrowheads).

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mentioning

confidence: 99%

Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

Bhatia

2012

Journal of Clinical and Experimental Hepatology

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“…A four-hand doctor's procedure with the help of two assistant nurses is recommended. Using EUS, the endoscopist can directly proof the clotting effect in the particular varix and add sequentially histoacryl boluses, as long the veins have still blood flow, what stands for a higher bleeding recurrence [22]. In case of active, even massive bleeding EUS controlled histoacrylate injection is successfully possible without the time consuming gastric rinsing.…”

Section: Discussionmentioning

confidence: 99%

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

Gubler¹,

Bauerfeind²

2014

Scandinavian Journal of Gastroenterology

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OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. RESULTS: Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. CONCLUSION: Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl. Safe and successful endoscopic initial treatment and long term eradication of gastric varices by EUS-guided Histoacryl (N-butyl-2-cyanoacrylate) injectionGubler C 1 , Bauerfeind P Material and methods: we present a large single center cohort over 7 years with a standardized endoscopic ultrasound guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow-up we repeated this treatment until varices were eradicated.Results: Utmost patients (36 of 40) were treated during or within 24 hours of active bleeding. 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only 2 patients suffered a minor complication. Acute bleeding was stopped in all patients. 15% (6/40) of patients needed an alternative rescue treatment in the longer course. 3 patients got a transjugular portosystemic shunt and another 3 underwent an orthotopic liver transplantation. Mean long term survival of 60 months was excellent.Conclusions: Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS guided injection of histoacryl.

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“…We previously reported use of ECDUS for evaluating the hemodynamics of esophago-gastric varices [11,12]. Iwase et al [13] reported that ECDUS is a useful method for the evaluation of gastric varices and for endoscopic obliteration of varices with cyanoacrylate glue.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasonographic findings before and after sclerotherapy for gastric varices

Sato

2010

J Med Ultrasonics

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Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue

Cited by 91 publications

References 12 publications

Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

Endoscopic ultrasonographic findings before and after sclerotherapy for gastric varices

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