Sheetal Patel, MD, Michael B. Wallace, MD, Victoria Gómez, MD  VideoGIE 

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EUS-guided placement of coils and glue for the management of large bleeding fundic varices  Sheetal Patel, MD, Michael B. Wallace, MD, Victoria Gómez, MD  VideoGIE  Volume 4, Issue 1, Pages 17-19 (January 2019) DOI: 10.1016/j.vgie.2018.09.005 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 CT view of abdomen and pelvis with intravenous contrast material performed on admission, showing cirrhosis of the liver with diffuse multifocal areas concerning for multifocal hepatocellular carcinoma, and evidence of bland and tumor thrombi within the portal vein. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 CT view showing a prominent, large splenorenal shunt with connection to the left renal vein. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Diagnostic EGD view demonstrating a large cluster of isolated gastric fundic varices with stigmata of recent hemorrhage. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 EUS view showing a large cluster of fundic gastric varices. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Placement of a total of 11 coils under EUS and fluoroscopic guidance, followed by injection of 12 mL cyanoacrylate glue. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Endoscopic view after intervention, demonstrating no active bleeding and a few coils that had partially migrated out into the gastric lumen. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 EUS view showing postacoustic shadowing from coils and glue injection; little to no flow identified within the treated gastric varices, indicating adequate treatment, with the caveat that coil and glue artifact could potentially obscure some areas of vascular flow. VideoGIE 2019 4, 17-19DOI: (10.1016/j.vgie.2018.09.005) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions