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DOI: 10.1055/s-0039-1681306
NOVEL EUS GUIDED TREATMENT OF GASTRIC VARICES WITH A LIQUID NON-ADHESIVE NEUROVASCULAR EMBOLIZATION AGENT
Publication History
Publication Date:
18 March 2019 (online)
Aims:
Endoscopic Injection of adhesive agents as N-Butyl-2-Cyanoacrylate (NBC) is used for the management of gastric varices. Recently the combination of NBC and coils has been used with endoscopic ultrasound assistance. Adhesive properties can blockage instrumentation material and damage endoscopes. Adverse events include ulcers, vascular necrosis, rebleeding and distal embolism. We describe a novel gastric varices embolization therapy with EUS injection of a composite non-adhesive endosvascular liquid agent: Ethylene-vinyl alcohol (EVOH), Tantalum as contrast media and Dimethylsulfoxide (DMSO) as primer. It has been extensively used in interventional radiology to treat cerebral arteriovenous malformations. Has the advantages of being radiopaque and inmediate polimerization.
Methods:
3 men and 2 women, 50 – 65 years with gastric fundus varices, portal hypertension and Child-B hepatic cirrhosis who presented previous bleeding were treated. Two patients had previously been treated with NBC and rebleding. The ecoendoscope was advanced to the gastroesophageal junction. The selected gastric varix punctured using a 22 Gauge needle. EVOH volume ranged between 1.5 and 3cc. Vascular flow obliteration was real time monitored by EUS.
Results:
Patients were discharged on the same day. The mean follow-up was 12 months. Endoscopic and radiological control was performed at 1 and 3 months.
The average procedure time was 15 min. All patients presented mild epigastric pain efectively managed with oral analgesics The obliteration of variceal flow was achieved in all patients in a single session. There were no new episodes of bleeding or complications related to the technique.
Conclusions:
EUS guided embolization of gastric vaices with EVOH can be considered as efficient alternative. The procedure promises advantages in terms of number of sessions required, local or systemic adverse events and endoscopes damage. Prospective multicenter study with greater number of cases and cost evaluation against coils alone or combined are required.