Endoscopic ultrasound coil placement of gastric varices: Emerging modality for recurrent bleeding gastric varices

Abstract

Gastric varices are the probable source of bleeding in 10-36% of patients, with acute variceal bleeding and carry high mortality and rebleeding rates. Till date, cyanoacrylate glue injection is considered as the standard of care but has high complication rate. Endoscopic ultrasound (EUS) guided coil placement is a new emerging technique of management of gastric varices. In this case report, we detail the EUS guided coil placement for management of gastric varices after failed glue injections.

Key words

Endoscopic ultrasound guided coil placement - gastric varices - variceal bleeding

• References

• 1 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-38.
• 2 Qureshi W, Adler DG, Davila R, Egan J, Hirota W, Leighton J, et al. ASGE Guideline: The role of endoscopy in the management of variceal hemorrhage, updated July 2005. Gastrointest Endosc 2005;62:651-5.
• 3 de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010;53:762-8.
• 4 Kang EJ, Jeong SW, Jang JY, Cho JY, Lee SH, Kim HG, et al. Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices. World J Gastroenterol 2011;17:1494-500.
• 5 Sarin SK, Kumar A. Gastric varices: Profile, classification, and management. Am J Gastroenterol 1989;84:1244-9.
• 6 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343-9.
• 7 Tan PC, Hou MC, Lin HC, Liu TT, Lee FY, Chang FY, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 2006;43:690-7.
• 8 Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol 2002;97:1010-5.
• 9 Mishra SR, Chander Sharma B, Kumar A, Sarin SK. Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: A randomised controlled trial. Gut 2010;59:729-35.
• 10 Belletrutti PJ, Romagnuolo J, Hilsden RJ, Chen F, Kaplan B, Love J, et al. Endoscopic management of gastric varices: Efficacy and outcomes of gluing with N-butyl-2-cyanoacrylate in a North American patient population. Can J Gastroenterol 2008;22:931-6.
• 11 Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, Subtil-Inigo JC, Junquera-Florez F, Gornals JB, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: A multicenter study (with videos). Gastrointest Endosc 2013;78:711-21.
• 12 Weilert F, Shah JN, Marson FP, Binmoeller KF. EUS-guided transesophageal treatment of gastric fundal varices with combined intravariceal coiling and cyanoacrylate glue injection using a front-view forward-array echoendoscope. Endoscopy 2011;43-A3.