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)

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Presentation transcript:

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) Yasser M. Bhat, MD, Frank Weilert, MD, R. Todd Fredrick, MD, Steven D. Kane, BS, Janak N. Shah, MD, Chris M. Hamerski, MD, Kenneth F. Binmoeller, MD Gastrointestinal Endoscopy Volume 83, Issue 6, Pages 1164-1172 (June 2016) DOI: 10.1016/j.gie.2015.09.040 Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, Large, type 1 isolated gastric variceal conglomerate in a patient with a history of bleeding. B, EUS showing same 4-cm varices conglomerate. C, Transesophageal deployment of coil through a 19-gauge needle. D, 1-month follow-up endoscopy showing markedly smaller variceal complex with cracked earth pattern suggesting obliteration. E, EUS showing variceal conglomerate at 1-month follow-up. Absent flow on color Doppler. F, 9-month follow-up showing eradicated varices. Gastrointestinal Endoscopy 2016 83, 1164-1172DOI: (10.1016/j.gie.2015.09.040) Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Flow diagram of all study patients. TIPS, transjugular intrahepatic portosystemic shunt; GFV, gastric fundal varices; IR, interventional radiology. Gastrointestinal Endoscopy 2016 83, 1164-1172DOI: (10.1016/j.gie.2015.09.040) Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Flow diagram of patients with EUS and/or clinical follow-up. Late post-treatment bleeding was defined as bleeding more than 6 months after index coil and glue treatment. FU, follow-up; PHTG, portal hypertensive gastropathy; AVM, arteriovenous malformation; EBL, endoscopic band ligation. Gastrointestinal Endoscopy 2016 83, 1164-1172DOI: (10.1016/j.gie.2015.09.040) Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Algorithm for management of gastric variceal bleeding. IGV-1, isolated gastric varices type 1; GOV-2, gastroesophageal varices type 2; EBL, endoscopic band ligation; CYA, cyanoacrylate. Gastrointestinal Endoscopy 2016 83, 1164-1172DOI: (10.1016/j.gie.2015.09.040) Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Flow diagram of patients treated for primary prophylaxis. Late bleeding was defined as bleeding more than 6 months after index coil and glue treatment. FU, follow-up. Gastrointestinal Endoscopy 2016 83, 1164-1172DOI: (10.1016/j.gie.2015.09.040) Copyright © 2016 American Society for Gastrointestinal Endoscopy Terms and Conditions