Outcomes of Endoscopic Ultrasound-Guided Obliteration for Large Gastric Varices: A Single-Center Experience

Background/Aims: Bleeding from gastric varices (GVs) carries high morbidity and mortality. Endoscopic ultrasound (EUS) has lately emerged as effective and safe modality for obliteration of GVs. We describe the safety and efficacy outcomes of EUS-obliteration for large gastric varices. Furthermore, we compare outcomes of procedures done for varices with/without prior bleeding, and with/without use of coils during the procedure.

Methods: We included patients who underwent EUS-guided obliteration for large GVs (>15 mm or carpeting the gastric fundus). GVs were identified with a linear echoendoscope, and a 19G needle used to inject glue with or without coils. Target was the feeder to the varix wherever identifiable, and undiluted n-butyl-cyanoacrylate glue was injected against the direction of flow to prevent systemic embolization ([Fig. 1]). Technical success was defined as obliteration of Doppler flow in the varix. Primary outcome was clinically evident systemic/pulmonary embolism. Secondary outcome was any variceal bleed after procedure.

Results: A total of 102 patients were included. In most patients (76/102; 75%) feeder to GV was targeted. Median size of varices was similar in Coil + glue vs. glue-only groups [(median, range) 37 mm (15–60 mm) vs. 30 mm(10–75 mm) p = NS]. Technical success was achieved in 100% cases. None of the patients in either group showed any evidence of systemic/pulmonary embolism.

Over a median follow-up of 239 days (range 6–848 days), any variceal bleed was seen in 15.6% cases (13% in primary prophylaxis vs. 17.5% in those with prior bleeding, p = NS). The use of coils with glue did not significantly affect risk of rebleeding over glue alone (28.5% in coil + glue, 13.6% in glue-only, p = NS), or amount of glue used [coils + glue vs. glue-only, median (range); 3 mL (2–12 mL) vs. 3 mL (1–7 mL), p = NS)].

Conclusions: EUS-guided variceal obliteration for large gastric varices was safe and effective both as primary and secondary prophylaxis. Outcomes with or without embolization coils too were similar with our technique of targeting feeders and injecting against the direction of flow

Fig. 1 Representative images of step-by-step obliteration of gastric varix by injecting glue into the feeder without the use of coils.

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Artikel online veröffentlicht:
22. April 2024