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EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos).
Gastrointest Endosc. 2013 Nov; 78(5):711-21.GE

Abstract

BACKGROUND

Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative.

OBJECTIVES

To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability.

DESIGN

Retrospective analysis of a prospectively maintained database.

SETTING

Multicenter study, tertiary referral centers.

PATIENTS AND INTERVENTIONS

Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment.

RESULTS

There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P < .01); only 3 were symptomatic, and an additional 9 (CYA group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding.

LIMITATIONS

Nonrandomized; EUS expertise necessary.

CONCLUSIONS

EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data.

Authors+Show Affiliations

Service of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study
Video-Audio Media

Language

eng

PubMed ID

23891417

Citation

Romero-Castro, Rafael, et al. "EUS-guided Coil Versus Cyanoacrylate Therapy for the Treatment of Gastric Varices: a Multicenter Study (with Videos)." Gastrointestinal Endoscopy, vol. 78, no. 5, 2013, pp. 711-21.
Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013;78(5):711-21.
Romero-Castro, R., Ellrichmann, M., Ortiz-Moyano, C., Subtil-Inigo, J. C., Junquera-Florez, F., Gornals, J. B., Repiso-Ortega, A., Vila-Costas, J., Marcos-Sanchez, F., Muñoz-Navas, M., Romero-Gomez, M., Brullet-Benedi, E., Romero-Vazquez, J., Caunedo-Alvarez, A., Pellicer-Bautista, F., Herrerias-Gutierrez, J. M., & Fritscher-Ravens, A. (2013). EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointestinal Endoscopy, 78(5), 711-21. https://doi.org/10.1016/j.gie.2013.05.009
Romero-Castro R, et al. EUS-guided Coil Versus Cyanoacrylate Therapy for the Treatment of Gastric Varices: a Multicenter Study (with Videos). Gastrointest Endosc. 2013;78(5):711-21. PubMed PMID: 23891417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). AU - Romero-Castro,Rafael, AU - Ellrichmann,Mark, AU - Ortiz-Moyano,Carlos, AU - Subtil-Inigo,Jose Carlos, AU - Junquera-Florez,Felix, AU - Gornals,Joan B, AU - Repiso-Ortega,Alejandro, AU - Vila-Costas,Juan, AU - Marcos-Sanchez,Francisco, AU - Muñoz-Navas,Miguel, AU - Romero-Gomez,Manuel, AU - Brullet-Benedi,Enric, AU - Romero-Vazquez,Javier, AU - Caunedo-Alvarez,Angel, AU - Pellicer-Bautista,Francisco, AU - Herrerias-Gutierrez,Juan M, AU - Fritscher-Ravens,Annette, Y1 - 2013/07/25/ PY - 2012/11/12/received PY - 2013/05/08/accepted PY - 2013/7/30/entrez PY - 2013/7/31/pubmed PY - 2014/5/30/medline KW - B-RTO KW - CYA KW - ECA KW - EUS-guided coils application KW - GV KW - TIPS KW - balloon-occluded retrograde transvenous obliteration KW - cyanoacrylate KW - gastric varices KW - transjugular portosystemic shunt SP - 711 EP - 21 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 78 IS - 5 N2 - BACKGROUND: Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative. OBJECTIVES: To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability. DESIGN: Retrospective analysis of a prospectively maintained database. SETTING: Multicenter study, tertiary referral centers. PATIENTS AND INTERVENTIONS: Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment. RESULTS: There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P < .01); only 3 were symptomatic, and an additional 9 (CYA group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding. LIMITATIONS: Nonrandomized; EUS expertise necessary. CONCLUSIONS: EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/23891417/EUS_guided_coil_versus_cyanoacrylate_therapy_for_the_treatment_of_gastric_varices:_a_multicenter_study__with_videos__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(13)01886-5 DB - PRIME DP - Unbound Medicine ER -