Original articleClinical endoscopyEUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos)
Section snippets
Patients
Our center has offered CYA injection for bleeding GFV since March 2002 under a U.S. Food and Drug Administration investigational device exemption and is a regional referral center for this type of therapy. After encountering one CYA failure in which emergent EUS-guided coiling (performed with consultative input from our interventional radiology service) was needed for hemostasis,17 we have offered combined EUS-guided coil and CYA treatment for patients referred for gastric variceal hemorrhage.
Results
Thirty patients with bleeding from GFV were treated between March 2009 and February 2011. Patient characteristics and endoscopic findings are summarized in Table 1. In 93% of patients, only 1 coil was used. Patients with acute or recent (<1 week) bleeding were hospitalized and taking octreotide at time of treatment; the remaining were outpatients (n = 10). Fifteen patients (48%) were taking beta-blockers and maintained this therapy during the follow-up period.
GFV were well visualized
Discussion
Endoscopic CYA injection of GFV has demonstrated higher hemostasis and lower rebleeding rates compared with band ligation or sclerotherapy.2, 3, 20 Delivery of CYA under EUS guidance has been previously reported and has the advantages of enabling precise delivery of glue into the varix lumen and confirmation of vessel obliteration with Doppler.6, 7 Romero-Castro et al7 reported on EUS-guided injection of CYA into gastric varices in 5 patients. The authors targeted the perforating vein by using
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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Binmoeller at [email protected].