A review article on gastric varices with focus on the emerging role of endoscopic ultrasound-guided angiotherapy

Khoury, Tawfik; Nadella, Divya; Wiles, Alex C.; Marshall, Caitlin; Kumar, Manoj; Shapira, Gilad; Ludvik, Nicholas; Schumann, Alan; Mahamid, Mahmud; Mizrahi, Meir

doi:10.1097/meg.0000000000001200

Cited by 14 publications

(19 citation statements)

References 36 publications

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“…In our study population of patients with GOV II and IGV I, the combined therapy of EUS-guided coil deployment and cyanoacrylate injection resulted in a higher rate of variceal disappearance, a significantly lower rebleeding rate, and a significantly ▶ Cirrhosis severity CYA, 2-octyl-cyanoacrylate; SD, standard deviation; MELD, model of endstage liver disease. 1 Student's t test. 2 Chi-squared test.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

et al. 2020

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Background Gastric variceal bleeding is a life-threating condition with challenging management. We aimed to compare the efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization and cyanoacrylate injection versus EUS-guided coil embolization alone in the management of gastric varices. Methods A single-center, parallel-randomized controlled trial involving 60 participants with gastric varices (GOV II and IGV I) who were randomly allocated to EUS-guided coil embolization and cyanoacrylate injection (n = 30) or EUS-guided coil embolization alone (n = 30). The primary end points were the technical and clinical success rates of both procedures. The secondary end points were the reappearance of gastric varices during follow-up, along with rebleeding, the need for reintervention, and complication and survival rates. Results The technical success rate was 100 % in both groups. Immediate disappearance of varices was observed in 86.7 % of patients treated with coils and cyanoacrylate, versus 13.3 % of patients treated with coils alone (P < 0.001). Median survival time was 16.4 months with coils and cyanoacrylate versus 14.2 months with coils alone (P = 0.90). Rebleeding occurred in 3.3 % of patients treated with combined treatment and 20 % of those treated with coils alone (P = 0.04). With combined treatment, 83.3 % of patients were free from reintervention versus 60 % with coils alone (hazard ratio 0.27; 95 % confidence interval 0.095 – 0.797; P = 0.01). Conclusions EUS-guided coil embolization with cyanoacrylate injection achieved excellent clinical success, with lower rates of rebleeding and reintervention than coil treatment alone. Multicenter studies are required to define the most appropriate technique for gastric variceal obliteration.

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Section: Discussionmentioning

confidence: 99%

“…Bleeding from gastric varices is more severe and life-threatening than bleeding from esophageal varices and is associated with high mortality and morbidity rates [1]. Management of bleeding from gastric varices is challenging and requires expertise because aggressive rebleeding can occur [1,2].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

et al. 2020

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“…EUS guided combined coil and glue injection is preferred EUS guided gastric variceal obliteration modality as it is associated with high variceal obliteration method with lower adverse effects as compared to either EUS guided coil or glue injection alone. 6,10 The efficacy of EUS guided variceal obliteration technique can be further increased if the afferent perforating vessel can be directly targeted thereby directly blocking the blood inflow to the varices. 5,8,9 Accurate diagnosis of afferent perforators usually requires injection of contrast…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Endoscopic Ultrasound-Guided Coil and Glue Injection for Bleeding Gastric/Ectopic Varices

Rana

Sharma

Dhalaria

et al. 2021

Techniques and Innovations in Gastrointestinal Endoscopy

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“…Cyanoacrylate (glue) treatment uses N-butyl-2-cyanoacrylate. Following administration, cyanoacrylate is polymerized and exerts its effects instantly within 20 s [13,14,15,16,17,18,19,20,21,22,23,24]. The fatty contrast agent lipiodol ultra-fluid (Therapex, Canada) is used to avoid occlusion in the endoscopy channel during the procedure.…”

Section: Treatmentmentioning

confidence: 99%

Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

Göral

Yılmaz

2019

Medicina

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Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.

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A review article on gastric varices with focus on the emerging role of endoscopic ultrasound-guided angiotherapy

Abstract: EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.

Cited by 14 publications

References 36 publications

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

Contrast-Enhanced Endoscopic Ultrasound-Guided Coil and Glue Injection for Bleeding Gastric/Ectopic Varices

Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

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