ENDOSCOPIC ULTRASOUND-GUIDED ANGIOTHERAPY WITH COMBINED COILS AND GLUE INJECTION FOR GASTRIC VARICES: AN EUROPEAN PILOT STUDY

Aims Gastric varices (GV) represent 20% of patiens with portal hypertension.

Endoscopic cyanoacrylate injection is recommended in bleeding gastric varices.

Nevertheless, it´s associated with more than 25% of re-bleeding and serious adverse events, mainly glue embolization. Endoscopic ultrasound (EUS)-guided and combined coil and glue injection provide a new alternative treatment for bleeding varices.

Methods This is a retrospective analysis of EUS-guided coil and glue injection for gastric varices bleeding from 10/2013 to 03/2019. We used linear therapeutic ultrasound endoscopes (Pentax EG-3870UTK and EG-38-J10UT) without fluoroscopic control. The procedures were performed on general anesthesia and antibioprophylaxia. We injected cyanoacrylate combined with Lipiodol after the application of one or many coils. A control EUS was done at 4 weeks. The primary outcomes were varices obliteration and the need of reintervention.

Results 33 patients were treated by EUS-guided coil and glue injection, 26 (78%) for recent bleeding varices and 7 (22%) for primary prophylaxis.There was 60% of males and the mean age is 61 years (28-84). Technical success was achieved in all patients (100%). The mean number of coil was 1.2 (1-3 coils) and the mean volume of glue injected was 1.5 mL (0.5-3 mL). Complete obliteration was confirmed for the 33 patients (100%), 30 after one session (91%), 2 after 2 sessions and one after 4 sessions. Post-procedure pain occured in 3 patients (9%) during 1 to 7 days. No symptomatic embolization was observed with a mean follow-up of 436 days (21-1818).

Conclusions EUS-guided combined coil and glue injection for gastric and ectopic varices appears to be a feasible and highly effective technique with less re-bleeding and complication than the classic endoscopic glue-only injection.