OBLITERATION OF GASTRIC VARICES GUIDED BY ECO-ENDOSCOPY WITH COILS INSERTION COATED WITH EXPANDABLE HIDROGEL POLYMERS

Introduction:

Bleeding from gastric varices is a severe complication of portal hypertension, with few management alternatives, especially when there is a contraindication to TIPS. The usual therapeutic options are the injection of cyanoacrylate, the insertion of coils or both.

The Hydrocoil, are used in neurovascular interventionism, allowing a rapid occlusion of the vessel forming a mesh that favours the local formation of thrombus and the development of a neointima on the gel cover. We consider its use for the vessel's obliteration in the treatment of gastric varices, without using cyanoacrylate.

Objective:

The aim of this study is to evaluate the safety and effectivity of the application of USE-guided hydrocoils in patients that bleed from gastric varices with TIPS contraindication.

Material and methods:

Retrospective series of cases including four patients with TIPS contraindication after evaluation form an interventional radiologist. We used linear echoendoscopes, fluoroscopy, 19G needles and hydrocoils (AZUR, Terumo), Progreat 3Fr microcatheters. The procedures were advised by an expert interventional radiologist. The obliteration of the vessel is confirmed by endoscopic ultrasound.

Results:

Technical and clinical success was reached in all 4 patients included. There were no adverse effects related to the procedure or equipment damage.

Conclusions:

The application of USE-guided Hydrocoils can be a safe and effective method in bleeding from gastric varices in patients not candidates for TIPS. It could also ensure a complete obliteration of the vascular lumen and thus dispense with the use of cyanoacrylate. Longer studies are needed to corroborate these preliminary results.