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Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices.
Clin Transl Gastroenterol. 2020 05; 11(5):e00175.CT

Abstract

INTRODUCTION

Gastric variceal (GV) bleeding is a feared complication of cirrhosis. Traditional endoscopic treatment with cyanoacrylate (CYA) injection can be challenging. Alternatively, endoscopic ultrasound (EUS)-guided delivery of hemostatic coils has shown high therapeutic success without the complications profile of CYA alone. Our aim was to compare the clinical outcomes of EUS-guided coil embolization with endoscopic CYA injection for the treatment of GV.

METHODS

We performed a matched cohort study using a prospective registry involving 2 tertiary centers. A total of 10 patients undergoing EUS-based coil therapy were matched in 1:3 fashion to 30 patients who underwent CYA injection. The matching criteria included type of GV, Charlson comorbidity index, and bleeding severity. Primary outcomes were technical success and complications. Secondary outcomes were rebleeding rates, reinterventions rates, total transfusion requirements, and time-to-event analysis (rebleeding, reintervention, and transfusion).

RESULTS

Technical success was 100% for EUS coil therapy vs 96.7% for CYA injection (P = 1.0). Complication rates were 10% in the EUS coil group vs 20% in the CYA group; P = 0.65. At 9 months, no EUS coil patient had rebled compared with 38% of the CYA group. No EUS coil patient required blood transfusion for GV rebleed, whereas over 50% of CYA patients did. Ten percent of EUS coil patients required reintervention compared with 60% of CYA patients. The EUS coil group had superior time to reintervention, GV rebleed, and transfusions (all P < 0.05).

DISCUSSION

Compared with CYA, EUS-guided coil injection appears superior for the treatment of GV and should be considered initial endoscopic treatment of choice in centers with interventional EUS expertise.

Authors+Show Affiliations

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32677809

Citation

Bazarbashi, Ahmad Najdat, et al. "Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices." Clinical and Translational Gastroenterology, vol. 11, no. 5, 2020, pp. e00175.
Bazarbashi AN, Wang TJ, Jirapinyo P, et al. Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices. Clin Transl Gastroenterol. 2020;11(5):e00175.
Bazarbashi, A. N., Wang, T. J., Jirapinyo, P., Thompson, C. C., & Ryou, M. (2020). Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices. Clinical and Translational Gastroenterology, 11(5), e00175. https://doi.org/10.14309/ctg.0000000000000175
Bazarbashi AN, et al. Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices. Clin Transl Gastroenterol. 2020;11(5):e00175. PubMed PMID: 32677809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices. AU - Bazarbashi,Ahmad Najdat, AU - Wang,Thomas J, AU - Jirapinyo,Pichamol, AU - Thompson,Christopher C, AU - Ryou,Marvin, PY - 2020/7/18/entrez PY - 2020/7/18/pubmed PY - 2021/5/21/medline SP - e00175 EP - e00175 JF - Clinical and translational gastroenterology JO - Clin Transl Gastroenterol VL - 11 IS - 5 N2 - INTRODUCTION: Gastric variceal (GV) bleeding is a feared complication of cirrhosis. Traditional endoscopic treatment with cyanoacrylate (CYA) injection can be challenging. Alternatively, endoscopic ultrasound (EUS)-guided delivery of hemostatic coils has shown high therapeutic success without the complications profile of CYA alone. Our aim was to compare the clinical outcomes of EUS-guided coil embolization with endoscopic CYA injection for the treatment of GV. METHODS: We performed a matched cohort study using a prospective registry involving 2 tertiary centers. A total of 10 patients undergoing EUS-based coil therapy were matched in 1:3 fashion to 30 patients who underwent CYA injection. The matching criteria included type of GV, Charlson comorbidity index, and bleeding severity. Primary outcomes were technical success and complications. Secondary outcomes were rebleeding rates, reinterventions rates, total transfusion requirements, and time-to-event analysis (rebleeding, reintervention, and transfusion). RESULTS: Technical success was 100% for EUS coil therapy vs 96.7% for CYA injection (P = 1.0). Complication rates were 10% in the EUS coil group vs 20% in the CYA group; P = 0.65. At 9 months, no EUS coil patient had rebled compared with 38% of the CYA group. No EUS coil patient required blood transfusion for GV rebleed, whereas over 50% of CYA patients did. Ten percent of EUS coil patients required reintervention compared with 60% of CYA patients. The EUS coil group had superior time to reintervention, GV rebleed, and transfusions (all P < 0.05). DISCUSSION: Compared with CYA, EUS-guided coil injection appears superior for the treatment of GV and should be considered initial endoscopic treatment of choice in centers with interventional EUS expertise. SN - 2155-384X UR - https://www.unboundmedicine.com/medline/citation/32677809/Endoscopic_Ultrasound_Guided_Coil_Embolization_With_Absorbable_Gelatin_Sponge_Appears_Superior_to_Traditional_Cyanoacrylate_Injection_for_the_Treatment_of_Gastric_Varices_ L2 - https://doi.org/10.14309/ctg.0000000000000175 DB - PRIME DP - Unbound Medicine ER -