EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)

Abstract

EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, post-treatment bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization.

Endoscopic ultrasound-guided vascular intervention for portal hypertension

“…[10][11][12][13][14][15][16] Fig. 3 illustrate GV obliteration by EUSguided CYA injection with Doppler monitoring.…”

“…[10][11][12][13][14][15][16] In general, a 19 G or 22 G standard EUS needle can be used for EUSguided intravascular puncture of the target varices. [10][11][12][13][14][15][16] Tissue adhesives in the form of CYA (e.g., N-butyl-2-CYA, 2-Octyl-CYA) with or without lipiodol, or sclerosing agents (e.g., ethanolamine) have been used for EUS-guided injection therapy of gastroesoph- A B ageal varices.…”

“…[10][11][12][13][14][15][16] In general, a 19 G or 22 G standard EUS needle can be used for EUSguided intravascular puncture of the target varices. [10][11][12][13][14][15][16] Tissue adhesives in the form of CYA (e.g., N-butyl-2-CYA, 2-Octyl-CYA) with or without lipiodol, or sclerosing agents (e.g., ethanolamine) have been used for EUS-guided injection therapy of gastroesoph- A B ageal varices. [10][11][12][13][14][15][16] While fluoroscopy is not required during injection therapy of varices with CYA under EUS guidance, fluoroscopy can be beneficial during EUS-guided coiling procedures with or without CYA injection.…”

“…[10][11][12][13][14][15][16] Tissue adhesives in the form of CYA (e.g., N-butyl-2-CYA, 2-Octyl-CYA) with or without lipiodol, or sclerosing agents (e.g., ethanolamine) have been used for EUS-guided injection therapy of gastroesoph- A B ageal varices. [10][11][12][13][14][15][16] While fluoroscopy is not required during injection therapy of varices with CYA under EUS guidance, fluoroscopy can be beneficial during EUS-guided coiling procedures with or without CYA injection. After injection therapy, EUS Doppler is used to provide real-time monitoring of variceal flow obliteration.…”

Endoscopic Doppler Ultrasound Probe: Useful in the Management of Gastric Varices?

“…Various methods including endoscopic ultrasound (EUS)-guided CYA and/or coil deployment [6] and using lipiodol-diluted CYA and undiluted CYA have been used & Virendra Singh virendrasingh100@hotmail.com to limit volume, to confirm obliteration, and to avoid adverse events [7]. In EUS-guided CYA and/or coiling therapy, the use of color Doppler helps identify GV and also enables the operator to confirm vessel obliteration.…”