PDF herunterladen
CC BY 4.0 · Endoscopy 2025; 57(S 01): E73-E74
DOI: 10.1055/a-2512-4927
E-Videos

Endoscopic ultrasound-guided coiling and glue injection for bleeding from isolated rectal varices

Yu Tang 
1   Gastroenterology, The People’s Hospital of Leshan, Southwest Medical University, Leshan, China
,
Min Xie
1   Gastroenterology, The People’s Hospital of Leshan, Southwest Medical University, Leshan, China
,
Xiaoling Zhou
2   Health Care Center, The People’s Hospital of Leshan, Southwest Medical University, Leshan, China
,
Junyi Zhuo
1   Gastroenterology, The People’s Hospital of Leshan, Southwest Medical University, Leshan, China
,
Xianfei Zhong 
1   Gastroenterology, The People’s Hospital of Leshan, Southwest Medical University, Leshan, China
› InstitutsangabenGefördert durch: Sichuan Medical Science and Technology Innovation Research Association YCH-KY-YCZD2024-135
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

A 73-year-old woman with hepatitis B-related cirrhosis was referred to our hospital with recurrent episodes of hematochezia. Computed tomography (CT) revealed the presence of the rectal–pelvic variceal plexus, as well as ascites ([Fig. 1]). Colonoscopy identified isolated varices with stigmata of recent bleeding in the upper rectum ([Fig. 2]). Endoscopic ultrasound (EUS) demonstrated that the rectal varices measured 20 mm in diameter and were connected to extraluminal varices via perforating veins ([Fig. 3] a, b).

Zoom Image
Fig. 1 Contrast-enhanced computed tomography image showing the rectal–pelvic variceal plexus and ascites.
Zoom Image
Fig. 2 Colonoscopy images showing: a isolated varices; b stigmata of recent bleeding in upper rectum.
Zoom Image
Fig. 3 Endoscopic ultrasound (EUS) images showing the rectal varices: a, b prior to injection; c, d after coil deployment and subsequent glue injection, with a significant reduction in Doppler flow.

After the available therapeutic options had been discussed with the patient, she opted for EUS-guided coiling and glue embolization for initial hemostasis. Under EUS guidance, a 19-gauge needle preloaded with a 0.035-inch × 10-mm × 14-cm embolization coil (Nester, Cook Medical, Bloomington, Indiana, USA) was used to puncture the varices. After the coil had been deployed, 1 mL of cyanoacrylate glue and 1.5 ml of lauromacrogol were injected ([Video 1]). A significant reduction in Doppler flow was observed, confirming the obliteration of the varices ([Fig. 3] c, d). No adverse events were reported during or after the procedure. A post-procedural plain radiograph revealed the coil positioned in the pelvis ([Fig. 4]). The patient did not experience any recurrence of hematochezia during a follow-up period of 6 months.


Qualität:
Successful treatment of bleeding from isolated rectal varices with endoscopic ultrasound-guided coiling and glue injection.Video 1

Zoom Image
Fig. 4 Post-procedural plain radiograph showing the coil in the pelvis.

There is currently no consensus regarding the optimal therapeutic strategy for managing hemorrhage from isolated rectal varices. Endoscopic glue injection alone guided by fluoroscopy has recently been recommended [1]. EUS not only facilitates precise intravariceal delivery of embolizing agents, but also allows for real-time monitoring of the therapeutic effect. The deployment of a coil serves as a scaffold for the glue, thereby reducing the volume of glue required and minimizing the risk of ectopic embolization [2]. Our findings demonstrate that EUS-guided coiling, in conjunction with glue injection, is a safe, effective, and straightforward approach to achieving initial hemostasis in cases of bleeding from isolated rectal varices.

Endoscopy_UCTN_Code_TTT_1AS_2AZ

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.



Publikationsverlauf

Artikel online veröffentlicht:
29. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Matsui S, Kashida H, Takita M. et al. Endoscopic glue injection therapy with N-butyl-2-cyanoacrylate for bleeding from isolated large rectal varices. Endoscopy 2024; 56: E738-E739
    Thieme ConnectPubMedSuche in Google Scholar
  • 2 Messallam AA, Kumbhari V, Saxena P. et al. Large bleeding rectal varices treated with endoscopic ultrasound-guided coiling and cyanoacrylate injection. Endoscopy 2014; 46: E28-E29
    Thieme ConnectPubMedSuche in Google Scholar