Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique

Abstract

Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis. While some are successfully managed by repeat endoscopic intervention, a few fail to respond or are not amenable to endoscopic hemostasis. As of now, the next level of intervention is passed on to either surgeons or interventional radiologists. There is new evidence suggesting the increased utility of endoscopic ultrasound (EUS) in diagnosis and treatment of culprit vascular lesions across the gut. In addition, EUS-assisted technique has also been used in the primary prevention of bleeding from gastroesophageal varices. In this review article, we have summarized case series and reports describing the use of EUS-assisted hemostasis. Indications, techniques, complications and success rates reported are discussed. While most of the authors describe their experience with primary and secondary treatment of gastric varices, treatment of other gastrointestinal lesions with EUS assisted hemostatic techniques is also discussed.

Magnetic sphincter augmentation: Optimal patient selection and referral care pathways

“…Metal stents have been used for esophageal NVUGIH and post-sphincterotomy bleeding[18,19]. Some centers tout the usefulness of EUS-guided therapy and vascular (doppler) probes to assess arteries[20,21].…”

Successful obliteration of bleeding duodenal varices by EUS-guided injection of N -butyl-2-cyanoacrylate

“… 7 , 8 Reports have suggested an association between the risk of embolism and the amount of CA injected. 9 EUS enables confirmation of the injection needle entry into the varix and precise CA delivery into the varix in real time. 4 As a result, the amount of CA injected can be decreased.…”