Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

Abstract

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

Endoscopic Ultrasound-Guided Treatments for Non-Variceal Upper GI Bleeding: A Review of the Literature

“…Until recent times, these vessels have only been accessible to surgeons and interventional radiologists: EUS guidance now offers an attractive, minimally invasive, alternative access route for therapeutic vascular intervention. So far, EUS-guided vascular therapies have found greater application in the field of portal hypertensive GI bleeding, but also in the field of NVUGIB: techniques such as injections of glue, clotting factors, or sclerosing agents and insertion of embolization coils have been described [12,13]. Furthermore, an interesting application of endoscopic ultrasound in the setting of NVUGIB could be the Doppler endoscopic probe (DEP) which may be used at the time of diagnosis and treatment of an acute episode, in the risk stratification for rebleeding and clinical outcome [14,15].…”

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…Endoscopic ultrasound (EUS)guided coil embolization is a therapeutic option for treating gastric varices that involves the placement of microcoils into the varices leading to obliteration (67) . There are data from uncontrolled studies and case reports indicat ing that EUSguided coil embolization alone or in combination with glue injection can be used for treatment of gastric and ectopic varices (67) . However, these studies are very limited and, at this time, no recommendation can be made on EUSguided coil emboliza tion for prevention of rebleeding from gastric varices.…”

Sclerosis of Fundic Varices. Experience in a Reference Center in the South West of Colombia, 2011-2017

“…In our study, hemostatic control was achieved in 100% of CYA sclerosis caused by emergency bleeding. Previous studies such as Tantau et al [12] and Serón P [13] have shown that cyanoacrylate is not inferior to treatment with ligation of varicose veins and its results are equivalent to the use of TIPS (Transjugular intrahepatic portosystemic shunt) as shown in the study by Procaccini et al [14] , without the presence of technical problems such as development of portal vein thrombosis, and encephalopathy described with the use of TIPS (Transjugular intrahepatic portosystemic shunt). The advantages of cyanoacrylate sclerotherapy include direct bleeding control and evaluation, increased reliability, reduced equipment requirements, use of conventional supplies such as standard sclerotherapy needles, rapid bleeding control, and low probability of endoscope damage using the appropriate technique.…”