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Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices.
Surg Endosc. 2016 Apr; 30(4):1396-404.SE

Abstract

BACKGROUND

Endoscopic band ligation and glue injection are established techniques for variceal bleeding. As EUS may enhance variceal detection and improve therapeutic targeting, we aim to report our experience on EUS-guided coil embolization, with and without concomitant glue injection, of varices.

METHODS

A prospectively maintained EUS database was retrospectively reviewed to identify consecutive patients who underwent EUS-guided variceal angiotherapy. All patients had failed or were poor candidates for standard endoscopic, surgical, or interventional radiologic therapies. The main outcome measurements were rates of rebleeding and adverse events.

RESULTS

Fourteen patients [mean age 58 (SD 12) years, 50% male] underwent EUS-guided coil injection with (n = 4) or without (n = 10) concomitant glue injection to treat esophagogastric (n = 1), gastric (n = 5), duodenal (n = 3), or choledochal (n = 5) varices. Prior endoscopic and cross-sectional imaging detected only 57 and 64% of the varices seen. A mean of 5.1 (SD 1.9) coils and a median of 3.25 (range 2-3.5) mL of cyanoacrylate were injected during the initial procedure. During median follow-up of 12 (range 1-104) months, three patients died from unrelated causes and eight patients did not have further bleeding episodes. In the remaining three patients who had choledochal varices, the frequency and intensity of rebleeding decreased significantly. Only one asymptomatic adverse event occurred with coil migration to the liver.

CONCLUSIONS

EUS-guided angiotherapy of varices is safe and feasible in selected patients who failed conventional therapy, and should be considered in the clinical management of these patients.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. levy.michael@mayo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26139494

Citation

Fujii-Lau, Larissa L., et al. "Endoscopic Ultrasound (EUS)-guided Coil Injection Therapy of Esophagogastric and Ectopic Varices." Surgical Endoscopy, vol. 30, no. 4, 2016, pp. 1396-404.
Fujii-Lau LL, Law R, Wong Kee Song LM, et al. Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices. Surg Endosc. 2016;30(4):1396-404.
Fujii-Lau, L. L., Law, R., Wong Kee Song, L. M., Gostout, C. J., Kamath, P. S., & Levy, M. J. (2016). Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices. Surgical Endoscopy, 30(4), 1396-404. https://doi.org/10.1007/s00464-015-4342-3
Fujii-Lau LL, et al. Endoscopic Ultrasound (EUS)-guided Coil Injection Therapy of Esophagogastric and Ectopic Varices. Surg Endosc. 2016;30(4):1396-404. PubMed PMID: 26139494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices. AU - Fujii-Lau,Larissa L, AU - Law,Ryan, AU - Wong Kee Song,Louis M, AU - Gostout,Christopher J, AU - Kamath,Patrick S, AU - Levy,Michael J, Y1 - 2015/07/03/ PY - 2015/04/23/received PY - 2015/06/17/accepted PY - 2015/7/4/entrez PY - 2015/7/4/pubmed PY - 2016/12/15/medline KW - Angiotherapy KW - Coil KW - Cyanoacrylate KW - Endosonography KW - Varices SP - 1396 EP - 404 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 4 N2 - BACKGROUND: Endoscopic band ligation and glue injection are established techniques for variceal bleeding. As EUS may enhance variceal detection and improve therapeutic targeting, we aim to report our experience on EUS-guided coil embolization, with and without concomitant glue injection, of varices. METHODS: A prospectively maintained EUS database was retrospectively reviewed to identify consecutive patients who underwent EUS-guided variceal angiotherapy. All patients had failed or were poor candidates for standard endoscopic, surgical, or interventional radiologic therapies. The main outcome measurements were rates of rebleeding and adverse events. RESULTS: Fourteen patients [mean age 58 (SD 12) years, 50% male] underwent EUS-guided coil injection with (n = 4) or without (n = 10) concomitant glue injection to treat esophagogastric (n = 1), gastric (n = 5), duodenal (n = 3), or choledochal (n = 5) varices. Prior endoscopic and cross-sectional imaging detected only 57 and 64% of the varices seen. A mean of 5.1 (SD 1.9) coils and a median of 3.25 (range 2-3.5) mL of cyanoacrylate were injected during the initial procedure. During median follow-up of 12 (range 1-104) months, three patients died from unrelated causes and eight patients did not have further bleeding episodes. In the remaining three patients who had choledochal varices, the frequency and intensity of rebleeding decreased significantly. Only one asymptomatic adverse event occurred with coil migration to the liver. CONCLUSIONS: EUS-guided angiotherapy of varices is safe and feasible in selected patients who failed conventional therapy, and should be considered in the clinical management of these patients. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26139494/Endoscopic_ultrasound__EUS__guided_coil_injection_therapy_of_esophagogastric_and_ectopic_varices_ DB - PRIME DP - Unbound Medicine ER -