Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed

Mukkada, Roy J.; Antony, Rajesh; Chooracken, Mathew J.; Francis, Jose; Chettupuzha, Antony; Mathew, Pradeep G.; Augustine, Philip; Koshy, Abraham

doi:10.1007/s12664-018-0844-y

Cited by 21 publications

(18 citation statements)

References 14 publications

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“…From an initial total of 1286 studies, 180 records were screened and 144 full-length articles and abstracts were assessed. A total of 23 studies (851 patients) were included in the final analysis of EUS-guided therapy [6 -28] [17,21,24], and 1 each treated with EUS-thrombin [13], EUS-coil/thrombin [22], and EUS-coil/gelatin sponge [8]. We encountered three EUS-guided studies that were from the same cohort and/or overlapping cohorts [29 -31]; data from only the most recent and/or most appropriate comprehensive report were included.…”

Section: Search Results and Population Characteristicsmentioning

confidence: 99%

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis

Mohan

Chandan²,

Khan

et al. 2020

Endoscopy

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Background Gastric variceal bleeding carries significant mortality in the setting of portal hypertension. Among the endoscopic treatment options, endoscopic ultrasound (EUS)-guided glue and/or coil injection is a novel approach, but its role in the treatment of gastric varices is not established due to a lack of robust data. Methods We conducted a comprehensive search of several databases (inception to June 2019) to identify studies evaluating EUS in the treatment of gastric varices. Our primary goals were to estimate the pooled rates of treatment efficacy, obliteration and recurrence of gastric varices, early and late rebleeding, and adverse events with EUS-guided therapy in gastric varices. We also searched for studies that evaluated direct endoscopic glue (END-glue) injection for treatment of gastric varices, and used the pooled rates as comparators. Results 23 studies (851 patients) evaluating EUS-guided therapy were included. The pooled treatment efficacy was 93.7 % (95 % confidence interval [CI] 89.5 – 96.3, I 2 = 53.7), gastric varices obliteration was 84.4 % (95 %CI 74.8 – 90.9, I 2 = 77), gastric varices recurrence was 9.1 % (95 %CI 5.2 – 15.7, I 2 = 32), early rebleeding was 7.0 % (95 %CI 4.6 – 10.7, I 2 = 0), and late rebleeding was 11.6 % (95 %CI 8.8 – 15.1, I 2 = 22). The rates were comparable to END-glue therapy (28 studies, 3467 patients) except for obliteration, which was significantly better with EUS-guided therapy. On subgroup analysis, EUS-coil/glue combination showed superior outcomes. Conclusions EUS-guided therapy demonstrated clinical efficacy for treatment of gastric varices in terms of obliteration, recurrence, and long-term rebleeding, and may be superior to END-glue.

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Section: Search Results and Population Characteristicsmentioning

confidence: 99%

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis

Mohan

Chandan²,

Khan

et al. 2020

Endoscopy

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“…Endoscopic gastric varix obliteration with direct injection of N-butyl-2-cyanoacrylate into the varix, transjugular intrahepatic portosystemic shunt (TIPS), and balloon-occluded retrograde transvenous obliteration (B-RTO) are alternatives for treatment of GV hemorrhage; however, these techniques require skillful endoscopic and radiological expertise. Moreover, cyanoacrylate injection through standard gastroscopes is associated with a 25 % to 50 % rebleeding rate 5 , and even death secondary to glue embolism has been reported 6 7 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided placement of coils and cyanoacrylate embolization in refractory gastric variceal bleeding: a pediatric case report

et al. 2019

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Background and study aims Gastric variceal bleeding management is challenging, especially in the pediatric population. Endoscopic cyanoacrylate glue injection is considered the standard for management of gastric varices but it is associated with a high rebleeding rate. Endoscopic ultrasound (EUS)-guided placement of coils with cyanoacrylate is a newly available technique with a lower rebleeding rate but there are no reported cases using this technique in pediatric patients. We report on a 12-year-old child with liver cirrhosis and gastric variceal hemorrhage who was refractory to the endoscopic cyanoacrylate injection and in whom hemostasis was achieved without rebleeding following EUS-guided coiling and cyanoacrylate injection. Neither rebleeding nor varix reappearance was noted on 12-month follow-up. EUS-guided coiling and cyanoacrylate injection is safe and feasible in pediatric patients and could be considered as rescue therapy for treatment of refractory gastric variceal bleeding.

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“…Procedure steps were same as described for EUS-Coils-CYA injection. 10 Relook endoscopy was done immediately postprocedure to see for any bleeding at injection site. All patients were admitted and monitored for any adverse event for 48 hours, especially for rebleeding.…”

Section: Procedures Stepsmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

Sharma

Sharma²,

Singh

2020

Journal of Digestive Endoscopy

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Introduction Conventional n-butyl-cyanoacrylate (CYA) recommended for secondary prophylaxis of gastric varices (GV) is associated with significant rebleeding and glue embolism. Limited data are available on more successful and less risky endoscopic ultrasound-guided coils and CYA (EUS-Coils-CYA) injection in GV. Methods We present a retrospective case series of 12 patients with GV bleeding managed successfully with EUS-Coils-CYA injection leading to variceal eradication in 11 patients. Results From January 2018 to June 2019, 12 cases of GV, which were either bleeding or bled recently, were included. Complete obliteration was achieved in 91.6% of patients with 100% technical success. Mean number of deployed coils and volume of injected CYA glue were 1.16 and 1.58 mL, respectively. Conclusions EUS-guided angiotherapy is an effective and safe intervention for managing GV bleeding with high technical success rate.

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Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed

Abstract: EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

Cited by 21 publications

References 14 publications

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis

Endoscopic ultrasound-guided placement of coils and cyanoacrylate embolization in refractory gastric variceal bleeding: a pediatric case report

Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

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