Novel Endoscopic Therapy for Gastric Varices Using Direct Forward-Viewing Endoscopic Ultrasonography

Yokoyama, Keiji; Miyayama, Takashi; Uchida, Yotaro; Fukuda, Hiromi; Yamauchi, Ryo; Tsuchiya, Naoaki; Umeda, Kaoru; Takata, Kazuhide; Tanaka, Takashi; Inomata, Shinjiro; Morihara, Daisuke; Takeyama, Yoshifumi; Shakado, Satoshi; Sakisaka, Shotaro; Hirai, Fumihito

doi:10.1159/000510132

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…Moreover, due to this revolutionary technology still being in the premature stages of adaptation into clinical practice, a unified or standardized methodology doesn’t exist. Whether the type of echo-endoscope, the positioning during therapy or the type of equipment used, a non-universal approach makes room for variable clinical outcomes and technical success rates[ 60 ]. On the other hand, EUS-guided therapy has potential to improve and become a main staple in the management of gastric varices[ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Role of endoscopic ultrasound in vascular interventions: Where are we now?

Fugazza¹,

Khalaf²,

Colombo³

et al. 2022

WJGE

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From a mere diagnostic tool to an imperative treatment modality, endoscopic ultrasound (EUS) has evolved and revolutionized safer efficient options for vascular interventions. Currently it is an alternative treatment option in the management of gastrointestinal bleeding, primarily variceal type bleeding. Conventional treatment option prior to EUS incorporation had limited efficiency and high adverse events. The characterization and detail provided by EUS gives a cutting edge towards a holistically successful management choice. Data indicates that EUS-guided combination therapy of coil embolization and glue injection has the higher efficacy for the treatment of varices. Conversely, similar treatment options that exist for esophageal and other ectopic variceal bleeding was also outlined. In conclusion, many studies refer that a combination therapy of coil and glue injection under EUS guidance provides higher technical success with fewer recurrence and adverse events, making its adaptation in the guideline extremely favorable. Endo-hepatology is a novel disciple with a promising future outlook, we reviewed topics regarding portal vein access, pressure gradient measurement, and thrombus biopsy that are crucial interventions as alternative of radiological procedures. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the role of EUS in vascular interventions. We reviewed the role of EUS in variceal bleeding in recent studies, especially gastric varices and novel approaches aimed at the portal vein.

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Section: Discussionmentioning

confidence: 99%

Role of endoscopic ultrasound in vascular interventions: Where are we now?

Fugazza¹,

Khalaf²,

Colombo³

et al. 2022

WJGE

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“…6), liver abscess, splenic abscess, and endovascular treatments for gastric varices. [33][34][35][36][37][38] FV-EUS may be used if it is possible to insert the endoscope deeply into the digestive tract, if puncturing perpendicularly to the digestive tract is feasible, and if endoscopic images are useful for the procedures.…”

Section: Other Treatmentsmentioning

confidence: 99%

Forward viewing liner echoendoscopy for therapeutic interventions

Hara,

Okuno,

Haba

et al. 2024

Clin Endosc

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Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

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“…It has been proved that EUS can be used to accurately evaluate gastric varices (GVs). [ 59 ] Yokoyama and colleagues [ 60 ] evaluated the effectiveness of forward visual EUS (FV-EUS) for GVs by retrospectively analyzing 4 cases. Forward visual EUS can display endoscopic and ultrasound images in real time during the treatment.…”

Section: Introductionmentioning

confidence: 99%

“…When there is distance between the mucosal surface and vascular lumen or the blood flow site requires puncture as an additional treatment, FV-EUS demonstrates higher success rate and effect than oblique viewing therapy. [ 60 ] EUS-guided treatment of GVs is not widely used, but the implementation of the FV-EUS might facilitate the approach. [ 61 ]…”

Section: Introductionmentioning

confidence: 99%

Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities

Sun,

Zhao,

Shi

et al. 2023

Endosc Ultrasound

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There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.

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Novel Endoscopic Therapy for Gastric Varices Using Direct Forward-Viewing Endoscopic Ultrasonography

Cited by 3 publications

References 13 publications

Role of endoscopic ultrasound in vascular interventions: Where are we now?

Role of endoscopic ultrasound in vascular interventions: Where are we now?

Forward viewing liner echoendoscopy for therapeutic interventions

Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities

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