Endoscopic ultrasound-guided vascular therapy: is it safe and effective?

Abstract

Recent developments in therapeutic endoscopic ultrasound (EUS) have enabled new approaches to the management of refractory gastrointestinal bleeding, including EUS-guided sclerotherapy and vessel embolization. Few cases have been reported in the literature. Eight patients were admitted for severe, refractory gastrointestinal bleeding, seven of whom were actively bleeding. Causes of bleeding were gastric varices secondary to portal hypertension (n = 3); gastroduodenal artery aneurysm or fundal aneurysmal arterial malformation (n = 3); and Dieulafoy's ulcer (n = 2); the latter five patients having arterial bleeding. During the procedures, the bleeding vessel was punctured with a 19-gauge needle then injected with a sclerosing agent (cyanoacrylate glue [n = 6] or polidocanol 2 % [n = 2]) under Doppler control. The median follow-up time was 9 months (3 - 18 months). In all 10 endoscopic procedures were performed. The procedure was successful at the first attempt in seven out of eight patients (87.5 %). No clinical complications were observed, although in one case there was diffusion of cyanoacrylate in the hepatic artery. The seven successful cases all showed immediate and complete disappearance of the Doppler flow signal at the end of the procedure. This retrospective study highlights the utility of EUS-guided vascular therapy. However, more large randomized studies should be conducted to confirm these results.

EUS-Guided Vascular Procedures: A Literature Review

“…The procedure was successful in both cases treated with epinephrine injection and in two out of four treated with contact thermal coagulation [17]. Gonzalez et al successfully treated a patient who bled from the side branch of gastroduodenal artery with EUS-guided injection of cyanoacrylate, with no recurrence bleeding detected during 14-month followup [18]. …”

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

“…They then used Doppler to confirm the absence of blood flow after therapy and reported a 100% success rate with no re-bleeding at 12 months. Gonzalez et al have reported on the treatment of Dieulafoy lesions, a bleeding pancreatic tumor, a pancreatic pseudoaneurysm, and an intracystic splenic artery pseudoaneursym [30,31]. Thrombin injection via EUS for pancreatic pseudoaneurysm bleeding has also been described [32].…”

Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique

“…Authors of another study reported the role of EUS in managing gastric lesions like varices, Dieulafoy lesions and arterial malformations [Gonzalez et al 2012]. Sharma and Somasundaram described a patient with a bleeding rectal varix, controlled with the aid of EUS [Sharma and Somasundaram, 2010].…”

“…Echoendoscope Radial- [Rana et al 2011;Krystallis et al 2012] or linear-array [Kinzel et al 2014;Ribeiro et al 2001;Gonzalez et al 2012;Romero-Castro et al 2007, 2013Lahoti et al 2000;Binmoeller et al 2011;Law et al 2014;Bhat et al 2015] therapeutic echoendoscopes with color Doppler have been used by most endoscopists for localizing and targeting the feeding vessels.…”