Endoscopy 2019; 51(04): S27
DOI: 10.1055/s-0039-1681248
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Video upper GI 1 South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED TREATMENT OF GASTRIC FUNDAL VARICES WITH COMBINED INJECTION OF COILS AND CYANOACRYLATE GLUE: INITIAL EXPERIENCE OF A BRAZILIAN ACADEMIC INSTITUITION

R Gardone
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
,
F Retes
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
,
R Roda
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
,
C Gomes
2   Universidade Federal de Juiz de Fora, Belo Horizonte, Brazil
,
E Vilela
3   Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
,
V Arantes
1   Federal University of Minas Gerais, Belo Horizonte, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Conventional endoscopic treatment of gastric fundus varices (GOV 2/IGV 1) consists of the application of cyanoacrylate glue, however, such technique is associated with risk of embolization and re-bleeding.

The aim of this study was to evaluate the efficacy and complication rate of combined injection of coils and cyanoacrylate glue in the secondary prophylaxis of gastric fundus variceal bleeding.

Single-center retrospective review of prospectively collected data investigating consecutive patients that underwent EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue March 2018 and June 2018, at an Academic Institution. A trained operator performed procedures. Standard diagnostic upper endoscopy was first performed. EUS was performed using a forward-viewing curved linear array echoendoscope. Active flow within GFV was confirmed by color Doppler before treatment. The transesophageal approach was preferred. EUS-directed intravascular puncture of the GFV was performed using a standard FNA needle (19G) and two embolization coils 14 mm were delivered into the varix through the FNA needle. The immediate injection of 1-mL aliquots of n-butil-cyanoacrylate after coil deployment was made through the same needle. The main outcomes measured were hemostasis, obliteration on surveillance EUS, post-treatment bleeding rate and adverse events.

The technical success occurred in 6/6 cases (100%) and the therapeutic success in 6/6 cases (100%). There were no adverse events. Control with echoendoscopy at 8 weeks showed no doppler flow in all six cases. During the follow-up period (156 days, range 56 – 206), there was no recurrence of bleeding.

EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue proved to be safe and effective in this small series of cases. Especially in patients with portosythemic shunt, combined EUS-guided treatment treatment should be considered.