Original articleClinical endoscopyEUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos)
Section snippets
Patients and methods
From February 2008 to May 2012, 30 patients with GV were enrolled in the study. Written informed consent was obtained in all cases. The study protocol was approved by the local ethics committee.
Endoscopy
Linear-array therapeutic echoendoscopes (EG 3830UT; Pentax, Hamburg, Germany or GF-UCT140-AL5; Olympus, Hamburg, Germany) with 3.8- or 3.7-mm working channels and elevator were used, attached to an US console (EUB 525 or Avius Hitachi, Tokyo, Japan or Aloka Prosound Alpha 5, Tokyo, Japan) allowing color Doppler imaging. The accessory channel of the echoendoscope was flushed with povidone-iodine (Meda Pharma, Solna, Sweden) to minimize the risk of contamination while the echoendoscope was passed
Patient characteristics and history of GV
Thirty patients (mean age, 60.1 ± 8.7 years, 22 males) were included in the study. The etiology of GV included alcoholism (n = 10), chronic hepatitis B/C infection (n = 13), liver cirrhosis of unknown etiology (n = 6), hepatocellular carcinoma (n = 3), and nonalcoholic steatohepatitis (n = 1). Patients were classified according to Child-Pugh class: A (n = 10), B (n = 13), and C (n = 7). All patient characteristics are summarized in Table 1.
Twenty-three patients (76.7%) had previously bled from
Discussion
GV hemorrhage is associated with high mortality and rebleeding rates. This is the finding of the controlled clinical trials available.14, 21, 23, 26, 27, 31 There is also some lack of understanding of the local vascular structure and hemodynamics of GV.1 According to the Sarin classification,29 gastroesophageal varices type I can be treated as esophageal varices, whereas GV type 2 (or intragastric varices type 1 (isolated gastric varices type I) should be handled specifically. Their first-line
Acknowledgment
No external funding was received to conduct the study. There was especially no support by the manufacturers of CYA or EUS-placed coils.
References (47)
Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension
J Hepatol
(2005)- et al.
Cost-effectiveness of N butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding
Am J Gastroenterol
(2003) - et al.
A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices
Am J Gastroenterol
(2002) - et al.
Endoscopic removal of sclerotherapy needle from gastric varix after N-butyl-2-cyanoacrylate injection
Gastrointest Endosc
(2000) - et al.
Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension
Gastrointest Endosc
(2007) - et al.
Pulmonary embolization of 2-octyl cyanoacrylate after endoscopic injection therapy for gastric variceal bleeding
Mayo Clin Proc
(2004) - et al.
EUS−guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases
Gastrointest Endosc
(2007) - et al.
Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial
J Hepatol
(2011) - et al.
Standardized injection technique and regimen minimizes complication and ensures safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices
Gastrointest Endosc
(2005) - et al.
A lexicon for endoscopic adverse events: report of an ASGE workshop
Gastrointest Endosc
(2010)
A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices
Gastroenterology
Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis
Gastrointest Endosc
Endoscopic ultrasonographic signs of portal hypertension in cirrhosis
Gastrointest Endosc
EUS-guided injection of cyanoacrylate for bleeding gastric varices
Gastrointest Endosc
Dieulafoy’s disease: endosonographic detection and endosonography-guided treatment
Gastrointest Endosc
Transaortic EUS-guided FNA in the diagnosis of lung and lymph nodes
Gastrointest Endosc
Pericardial tumor diagnosed by EUS-guided FNA (with video)
Gastrointest Endosc
Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler
Gastrointest Endosc
Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue
Gastrointest Endosc
EUS-guided coil embolization for refractory ectopic variceal bleeding
Gastrointest Endosc
EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos)
Gastrointest Endosc
Management of gastric varices
J Gastroenterol Hepatol
Efficacy of balloon tamponade in the treatment of bleeding gastric and esophageal varices. Results in 151 consecutive episodes
Dig Dis Sci
Cited by (0)
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
See CME section; p. 763.
- ∗
Drs Romero-Castro and Ellrichmann contributed equally to this article.