Alpha 2.0
Login Register
» Articles » PMID: 39735397

Endoscopic Ultrasound-guided Therapies in the Treatment of Gastric Varices: An In-depth Examination of Associated Adverse Events

Overview
Journal World J Gastrointest Endosc
Publisher Baishideng Publishing Group
Date 2024 Dec 30
PMID 39735397
Authors
Anastasios Manolakis
Kyriaki Tsagkidou
Konstantinos Eleftherios Koumarelas
Affiliations
Soon will be listed here.
Abstract

The Baveno VII consensus, released in 2023, recommends that the endoscopic treatment of choice for managing bleeding gastric varices (GV) is endoscopic ultrasound (EUS)-guided treatment, specifically EUS-guided cyanoacrylate (CYA) glue injection. This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates, compared to other endoscopic techniques. Despite its efficacy, CYA injection for GV has been linked to rare but serious adverse events, such as glue embolization leading to pulmonary embolism, infection/bacteremia, splenic infarction, intra-procedural and post-procedural complications. The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance, aiming to more accurately direct the injection into the varix, reduce the volume of injected glue, target the perforating vein when possible, and confirm obliteration of GV Doppler examination.

References
1.
Bhat Y, Weilert F, Fredrick R, Kane S, Shah J, Hamerski C . EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video). Gastrointest Endosc. 2015; 83(6):1164-72. DOI: 10.1016/j.gie.2015.09.040. View
2.
Lobo M, Chaves D, Hourneaux de Moura D, Ribeiro I, Ikari E, de Moura E . SAFETY AND EFFICACY OF EUS-GUIDED COIL PLUS CYANOACRYLATE VERSUS CONVENTIONAL CYANOACRYLATE TECHNIQUE IN THE TREATMENT OF GASTRIC VARICES: A RANDOMIZED CONTROLLED TRIAL. Arq Gastroenterol. 2019; 56(1):99-105. DOI: 10.1590/S0004-2803.201900000-08. View
3.
Robles-Medranda C, Oleas R, Valero M, Puga-Tejada M, Baquerizo-Burgos J, Ospina J . Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial. Endoscopy. 2020; 52(4):268-275. DOI: 10.1055/a-1123-9054. View
4.
Bick B, Al-Haddad M, Liangpunsakul S, Ghabril M, DeWitt J . EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding. Surg Endosc. 2018; 33(6):1837-1845. DOI: 10.1007/s00464-018-6462-z. View
5.
Kouanda A, Binmoeller K, Hamerski C, Nett A, Bernabe J, Shah J . Safety and efficacy of EUS-guided coil and glue injection for the primary prophylaxis of gastric variceal hemorrhage. Gastrointest Endosc. 2021; 94(2):291-296. DOI: 10.1016/j.gie.2021.01.025. View