Comparison of endoscopic ultrasound-guided coil deployment with and without cyanoacrylate injection for gastric varices

Seven, Gülseren; Musayeva, Gunel; Seven, Ozden Ozluk; Herdan, Emre; İnce, Ali Tüzün; Şentürk, Hakan

doi:10.1016/j.ajg.2022.04.004

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…EUS–guided glue injection as monotherapy was performed in 4 studies, [ 23 – 26 ] EUS-coils were deployed as monotherapy in 5 studies, [ 24 , 27 – 30 ] combination EUS-coil + glue was performed in 9 studies, [ 26 , 28 , 30 – 36 ] EUS-guided thrombin injection was used in 1 study, [ 37 ] EUS-guided sclerosant (ethanolamine oleate) injection was used in 1 study [ 38 ] and EUS-guided coils and absorbable hemostatic gelatin sponge were used in 2 studies. [ 39 , 40 ]…”

Section: Resultsmentioning

confidence: 99%

“…The overall pooled rate of variceal obliteration was 83.6% (95% CI, 71.5%–91.2%; I 2 = 74; Supplementary Figure 3, http://links.lww.com/ENUS/A338 ). Among patients undergoing EUS-glue, [ 23 – 25 ] EUS-coil, [ 28 – 30 ] and combination EUS–glue and coil, [ 27 , 28 , 30 , 31 , 33 ] the rates were 84.6% (95% CI, 75.9%–90.6%; I 2 = 31), 91.6% (95% CI, 78.6%–97%; I 2 = 0), and 84.5% (95% CI, 50.8%–96.7%; I 2 = 75), respectively.…”

Section: Resultsmentioning

confidence: 99%

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EUS–guided therapies for primary and secondary prophylaxis in gastric varices—An updated systematic review and meta-analysis

Chandan,

Nguyen,

Mohan

et al. 2023

Endosc Ultrasound

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Background and Objectives Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS–guided therapies have been used in GV bleeding. Methods We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I 2 % statistics. Results Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1–95.2; I 2 = 0). With combination EUS–glue and coil therapy, the rate was 95.4% (CI, 86.7%–98.5%; I 2 = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%–12.4%; I 2 = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%–95.2%; I 2 = 12). With EUS-glue, EUS-coil, and combination EUS–glue and coil, the rates were 94.3% (CI, 88.9%–97.1%; I 2 = 0), 95.5% (CI, 80.3%–99.1%; I 2 = 0), and 88.7% (CI, 76%–95.1%; I 2 = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%–91.2%; I 2 = 74). With EUS-glue, EUS-coil, and combination EUS–glue and coil, the rates were 84.6% (CI, 75.9%–90.6%; I 2 = 31), 92.3% (CI, 81.1%–97.1%; I 2 = 0), and 84.5% (CI, 50.8%–96.7%; I 2 = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%–24.3%; I 2 = 16) and 20.6% (CI, 9.3%–39.5%; I 2 = 66), respectively. Conclusion Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

EUS–guided therapies for primary and secondary prophylaxis in gastric varices—An updated systematic review and meta-analysis

Chandan,

Nguyen,

Mohan

et al. 2023

Endosc Ultrasound

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“…Various studies published on EUS-guided vascular interventions in GV have been tabulated in Table 2 [ 39 - 47 ]. Published literature strongly supports using EUS-guided vascular therapy for managing GV for primary and secondary prophylaxis.…”

Section: Eus-guided Management Of Variceal Bleedmentioning

confidence: 99%

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Dhar¹,

Samanta²

2023

World J Gastrointest Endosc

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Endoscopic ultrasound (EUS) has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal (GI) diseases. The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions. EUS provides important clinical and anatomical information related to the vessels' size, appearance and location. Its excellent spatial resolution, use of colour doppler with or without contrast enhancement and ability to provide images “real-time” helps in precision while intervening vascular structures. Additionally, structures such as venous collaterals or varices can be dealt with optimally using EUS. EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension. It also helps to avoid radiation exposure in addition to being minimally invasive. These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions. EUS-guided portal vein (PV) access and therapy is a new kid on the block. EUS-guided portal pressure gradient measurement, injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology. Lastly, EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus. Herein, we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding, portal vein access and its related therapeutic interventions, cardiac access, and therapy. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.

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Endoscopic ultrasound in portal hypertension: navigating venous hemodynamics and treatment efficacy

Dragomir,

Pojoga,

Hagiu

et al. 2023

Gastroenterology Report

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Portal hypertension-related complications increase mortality in patients, irrespective of its etiology. Classically, endoscopic ultrasound (EUS) was used to assess the portal venous system and collaterals, considering size and hemodynamic parameters, which correlate with portal hypertension (PH) and related complications. Furthermore, therapeutic EUS guides treatment interventions, such as embolization of the gastric varices through coil placement and tissue adhesive injection, yielding encouraging clinical results. Recently, the direct measurement of portal pressure, emerging as an alternative to hepatic venous pressure gradient, has shown promise, and further research in this area is anticipated. In this review, we aimed to provide a detailed description of various possibilities for diagnosing vascular anatomy and hemodynamics in PH and actual knowledge on the EUS usefulness for PH vessel-related complications. Also, future promises for this field of endo-hepatology are discussed.

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Comparison of endoscopic ultrasound-guided coil deployment with and without cyanoacrylate injection for gastric varices

Cited by 3 publications

References 25 publications

EUS–guided therapies for primary and secondary prophylaxis in gastric varices—An updated systematic review and meta-analysis

EUS–guided therapies for primary and secondary prophylaxis in gastric varices—An updated systematic review and meta-analysis

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Endoscopic ultrasound in portal hypertension: navigating venous hemodynamics and treatment efficacy

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