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Case Reports
. 2019 Apr;47(4):1802-1809.
doi: 10.1177/0300060519830207. Epub 2019 Feb 28.

Endoscopic ultrasound-guided injection of coils and cyanoacrylate glue for the treatment of gastric fundal varices with abnormal shunts: a series of case reports

XiaoMing Wang  1 , Shan Yu  1 , Xin Chen  1 , Lei Duan  1
Affiliations
Case Reports

Endoscopic ultrasound-guided injection of coils and cyanoacrylate glue for the treatment of gastric fundal varices with abnormal shunts: a series of case reports

XiaoMing Wang et al. J Int Med Res. 2019 Apr.

Abstract

Gastric varices are found in approximately 20% of patients with portal hypertension. Endoscopic procedures involving the injection of cyanoacrylate (CYA) have proven to be the therapies of choice for primary treatment of gastric varices and have resulted in higher hemostasis rates and lower recurrent bleeding rates compared with band ligation and sclerotherapy. Nevertheless, serious adverse events associated with CYA injection, including glue embolization, have been reported in numerous articles and have occasionally led to fatal adverse events. Gastric fundal varices with abnormal shunts are higher-risk than those without abnormal shunts, and their treatment is more challenging. Endoscopic ultrasound (EUS)-guided puncture is an important technique in the field of digestive endoscopy. EUS has advantages that include improved therapeutic targeting, enhanced variceal detection, the ability to confirm varix obliteration with Doppler examination, and the ability to perform accurate observations of gastric varices that are not affected by blood in the stomach. The coils currently used for intravascular embolization can be precisely delivered into a varix through fine-needle puncture under EUS guidance, and this technique has provided a new approach for varix obliteration. We herein describe two patients with severe gastric fundal varices who were treated with EUS-guided coil injection and CYA embolization.

Keywords: Endoscopic ultrasound; coils; cyanoacrylate; gastric varices; intravascular embolization; portal hypertension.

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Figures

Figure 1.
Figure 1.
Endoscopic examination revealing severe isolated gastric varices.
Figure 2.
Figure 2.
Computed tomography imaging of the abdomen showing cirrhosis and gastric fundal varices with a splenorenal shunt.
Figure 3.
Figure 3.
Gastroduodenoscopy showing severe isolated gastric varices.
Figure 4.
Figure 4.
Computed tomography imaging of the portal vein suggesting cirrhosis, splenomegaly, and gastric fundal varices with splenorenal and gastrorenal shunts.
Figure 5.
Figure 5.
Endoscopic ultrasound view of the gastric fundal varix.
Figure 6.
Figure 6.
Endoscopic ultrasound color Doppler blood flow image of the inner vascular pattern of the gastric fundal varix.
Figure 7.
Figure 7.
Endoscopic ultrasound-guided puncture of a varix with a 19-G needle and coil deployment.
Figure 8.
Figure 8.
Endoscopic ultrasound-guided injection of a sclerosing agent and cyanoacrylate.
Figure 9.
Figure 9.
Endoscopic ultrasound color Doppler image showing the absence of blood flow in the gastric fundal varix after therapy.
Figure 10.
Figure 10.
Portal vein system computed tomography showing a gastric fundal varix that was significantly smaller after treatment.
Figure 11.
Figure 11.
Portal vein system computed tomography showing a gastric fundal varix that was significantly smaller after treatment.
See this image and copyright information in PMC

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