Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices

Abstract

EUS-guided angiotherapy of varices is safe and feasible in selected patients who failed conventional therapy, and should be considered in the clinical management of these patients.

Endoscopic ultrasound-guided vascular intervention for portal hypertension

“…In a case series of 14 patients, 3 patients with duodenal varices and 5 patients with choledochal varices who failed conventional therapies were treated with EUS-guided coil with or without CYA injection. 16 While there was no rebleeding from the treated duodenal varices, 3 out of the 5 treated patients with choledochal varices developed rebleeding, requiring placement of biliary covered metal stents by ERCP +/-repeated EUS-guided coil for hemostasis.…”

“…[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.…”