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EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases.
Gastrointest Endosc. 2007 Aug; 66(2):402-7.GE

Abstract

BACKGROUND

Bleeding from gastric varices can be challenging because of its high mortality and recurrent bleeding rates. Endoscopic therapy with tissue adhesives can control acute hemorrhage, but recurrent bleeding could appear if obliteration is not achieved, and endoscopic vision could be troublesome in the case of massive hemorrhage. The glue injected could be responsible for embolic phenomena and local complications. EUS has proved useful in minimizing the risk of recurrent bleeding from gastric varices, accurately showing if they are obturated or not. The presence of perforating veins detected by EUS has been reported as a risk factor for recurrent bleeding from esophageal varices.

OBJECTIVE

To assess the efficacy of EUS-guided cyanoacrylate injection in gastric varices at the entrance of the perforating veins to obtain variceal obturation.

DESIGN

Open-basis case series study.

SETTING

Tertiary care, academic medical center, Seville, Spain.

PATIENTS

Five consecutive patients with gastric varices were enrolled from May 2005 through May 2006.

INTERVENTIONS

We injected cyanoacrylate-lipiodol in gastric varices with 22-gauge needles by EUS guidance.

MAIN OUTCOME MEASUREMENTS

To analyze the obliteration of gastric varices, the recurrent bleeding rate, and safety of EUS-guided cyanoacrylate-lipiodol injection.

RESULTS

EUS-guided injection of the perforating veins by using cyanoacrylate-lipiodol was successful in eradicating gastric varices in the 5 patients treated, without recurrent bleeding or other complications during the study follow-up.

LIMITATION

This is a single-center nonrandomized study.

CONCLUSIONS

EUS-guided injection of cyanoacrylate at the level of the perforating veins in the treatment of gastric varices seems to be a safe, efficient, and accurate approach. Further controlled studies are warranted.

Links

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Authors+Show Affiliations

Romero-Castro R
Service of Gastroenterology, Service of Vascular Invasive Radiology, Virgen Macarena Hospital, Seville, Spain.
Pellicer-Bautista FJ
No affiliation info available
Jimenez-Saenz M
No affiliation info available
Marcos-Sanchez F
No affiliation info available
Caunedo-Alvarez A
No affiliation info available
Ortiz-Moyano C
No affiliation info available
Gomez-Parra M
No affiliation info available
Herrerias-Gutierrez JM
No affiliation info available

MeSH

CyanoacrylatesEndosonographyEsophageal and Gastric VaricesGastrointestinal HemorrhageHemostasis, EndoscopicHumansInjectionsIodized OilTissue AdhesivesUltrasonography, Interventional

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17643723

Clinical Trial Links

Angiography for Evaluation of the Feeder Vessel in EUS-guided Coils and Cyanoacrylate Therapy for Gastric Varices
Treatment of Gastric Varices Using EUS Guided Techniques
EUS-guided Obturation of High Risk Gastric Varices Versus Standard Endoscopic Treatment

Citation

Romero-Castro, Rafael, et al. "EUS-guided Injection of Cyanoacrylate in Perforating Feeding Veins in Gastric Varices: Results in 5 Cases." Gastrointestinal Endoscopy, vol. 66, no. 2, 2007, pp. 402-7.
Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66(2):402-7.
Romero-Castro, R., Pellicer-Bautista, F. J., Jimenez-Saenz, M., Marcos-Sanchez, F., Caunedo-Alvarez, A., Ortiz-Moyano, C., Gomez-Parra, M., & Herrerias-Gutierrez, J. M. (2007). EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointestinal Endoscopy, 66(2), 402-7.
Romero-Castro R, et al. EUS-guided Injection of Cyanoacrylate in Perforating Feeding Veins in Gastric Varices: Results in 5 Cases. Gastrointest Endosc. 2007;66(2):402-7. PubMed PMID: 17643723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. AU - Romero-Castro,Rafael, AU - Pellicer-Bautista,Francisco J, AU - Jimenez-Saenz,Manuel, AU - Marcos-Sanchez,Francisco, AU - Caunedo-Alvarez,Angel, AU - Ortiz-Moyano,Carlos, AU - Gomez-Parra,Manuel, AU - Herrerias-Gutierrez,Juan M, PY - 2006/11/07/received PY - 2007/03/04/accepted PY - 2007/7/24/pubmed PY - 2007/10/17/medline PY - 2007/7/24/entrez SP - 402 EP - 7 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 66 IS - 2 N2 - BACKGROUND: Bleeding from gastric varices can be challenging because of its high mortality and recurrent bleeding rates. Endoscopic therapy with tissue adhesives can control acute hemorrhage, but recurrent bleeding could appear if obliteration is not achieved, and endoscopic vision could be troublesome in the case of massive hemorrhage. The glue injected could be responsible for embolic phenomena and local complications. EUS has proved useful in minimizing the risk of recurrent bleeding from gastric varices, accurately showing if they are obturated or not. The presence of perforating veins detected by EUS has been reported as a risk factor for recurrent bleeding from esophageal varices. OBJECTIVE: To assess the efficacy of EUS-guided cyanoacrylate injection in gastric varices at the entrance of the perforating veins to obtain variceal obturation. DESIGN: Open-basis case series study. SETTING: Tertiary care, academic medical center, Seville, Spain. PATIENTS: Five consecutive patients with gastric varices were enrolled from May 2005 through May 2006. INTERVENTIONS: We injected cyanoacrylate-lipiodol in gastric varices with 22-gauge needles by EUS guidance. MAIN OUTCOME MEASUREMENTS: To analyze the obliteration of gastric varices, the recurrent bleeding rate, and safety of EUS-guided cyanoacrylate-lipiodol injection. RESULTS: EUS-guided injection of the perforating veins by using cyanoacrylate-lipiodol was successful in eradicating gastric varices in the 5 patients treated, without recurrent bleeding or other complications during the study follow-up. LIMITATION: This is a single-center nonrandomized study. CONCLUSIONS: EUS-guided injection of cyanoacrylate at the level of the perforating veins in the treatment of gastric varices seems to be a safe, efficient, and accurate approach. Further controlled studies are warranted. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/17643723/EUS_guided_injection_of_cyanoacrylate_in_perforating_feeding_veins_in_gastric_varices:_results_in_5_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)00423-3 DB - PRIME DP - Unbound Medicine ER -