Potential application of interventional endoscopic ultrasonography for the treatment of esophageal and gastric varices

Abstract

Interventional endoscopic ultrasonography (EUS) has been developed mainly for the treatment of pancreaticobiliary disorders (e.g. cyst drainage for pancreatic pseudocysts, biliary drainage for malignant biliary obstruction, and celiac plexus neurolysis). Recently, the application of interventional EUS has been expanded to a new field, the treatment of gastrointestinal varices. There have been several studies examining this new technique for the treatment of esophageal and gastric varices. In the present review, we have summarized the current status of interventional EUS for the treatment of esophageal and gastric varices (e.g. EUS-guided coil deployment for gastric varices) and clarified the clinical feasibility of this procedure.

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

“…A success rate of 75% has been demonstrated for GV eradication by EUS‐guided injection of coils . Recently, one review of four studies reported the advantages for this EUS‐guided approach; however, many details remain unresolved, such as targeting of the correct vessels in cases of splenic vein hypertension associated with portal vein hypertension, targeting of the feeder vessel, and the presence of shunts. In the present study, we described the results of patients treated by EUS‐guided coil insertion with the CYA injection technique with the addition of systematic EV for GV feeder vessel evaluation.…”

EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding

“…The technique of endoscopic treatment of GV was later refined with the use of EUSguidance [26,27,18,28,29] to theoretically direct injection of GV more accurately, minimize the volume of cyanoacrylate injected, target the perforating vein when possible and confirm GV eradication using Doppler examination [4]. Despite the theoretical advantages of EUS-guided fine needle injection (EUS-FNI) of cyanoacrylate over direct endoscopic injection (DEI) in the treatment of GV, currently no comparative studies exist between the two techniques.…”

New method of endoscopic injection sclerosis for esophageal varices using by modified endoscopic hood

“…Endoscopic ultrasonography‐guided injection sclerotherapy has been reported for the esophageal varices, 5 however, this technique is not yet a common method. This new modified endoscopic hood made esophageal EIS easier and safer.…”