Endoscopic‐ultrasound‐guided coil and cyanoacrylate embolization for gastric varices and the roles of endoscopic Doppler and endosonographic varicealography in vascular targeting

Abstract

Objective To report the results of endoscopic ultrasound‐guided injection of coils with cyanoacrylate (CYA) using a less‐expensive coil with an emphasis on the roles of Doppler and endosonographic varicealography (EV) in identifying the feeder vessel in gastric varix treatment. Methods An observational, descriptive study with prospectively collected data. Patients with gastric varices (GV) were included and were treated by endoscopic ultrasound‐guided injection of CYA and a less‐expensive coil. Technical success, complete and immediate variceal obliteration, rebleeding, complication and survival rates were evaluated. Results Thirty patients with GV with a mean age of 62 years (range: 44–76 years) were treated. Median number of coils used was 2 (range: 1–3), and median volume of CYA was 1.8 mL (1.2–2.4 mL). Technical success rate was 100%. EV technical success was observed in 26/30 patients. Complete variceal obliteration was observed in 96.6% of patients, and immediate disappearance of the varix was observed in 24 (80%) patients. The complication rate was 6.7%. Conclusions Endoscopic‐ultrasound guidance for gastric varix treatment with the addition of EV and the use of a less‐expensive coil is a safe and effective technique that results in the immediate disappearance of GV after targeting the feeding vessel.

Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis

“…From our findings, when cyanoacrylate is combined with endoscopic ultrasound guided coils to treat gastric varices the pooled risk of rebleeding is 0.07(confidence interval: 0.03-0.11). This finding is more or less similar to that reported by Bhat et al (2016) [43] but is higher than that reported by Robles-Medranda et al (2019) [44]. The reason for the differences could be explained by different sample sizes among studies pooled.…”

Endoscopic ultrasound-guided treatment of gastric varices with coil embolization and absorbable hemostatic gelatin sponge: a novel alternative to cyanoacrylate

“…Historically, endoscopic therapy for GV has relied on intravenous injection of acrylate polymers often used in conjunction with lipiodol, a radio-opaque ionized oil which slows polymerization of these polymers allowing more time for injection [19]. Cyanoacrylate injection has been associated with multiple complications [8][9][10][11][12], most notably systemic embolization (e. g. pulmonary embolism) in up to 2 % to 3 % of cases, and sclerosant or glue extrusion which can occur within 1 to 3 months and can lead to recurrent variceal bleeding [19][20][21]. Other complications include fevers, sepsis, and gastric ulcer formation.…”

“…associated with complications, such as systemic embolization, failed withdrawal of needle from variceal nest after injection and deep ulceration resulting in re-bleeding [8][9][10][11]. To mitigate against these complications, cyanoacrylate has been used as adjunctive therapy following hemostatic coils delivered intravascularly under endoscopic ultrasound (EUS) guidance [12,13]. Theoretically coils provide scaffolding for localized glue polymerization, however adverse events including rebleeding and embolization are still seen with combination therapy [13,14].…”

Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

“…Combination of coils and CYA glue in the afferent portion of the perforator has reported complete variceal obliteration in 96.6% of cases with 100% technical success rate and immediate disappearance of GV in 80% of patients in a recent study. 13 A recent systemic review and meta-analysis 14 showed that EUS-guided angiotherapy is safe and effective procedure with high technical success rate.…”