EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos)

• Published in: Gastrointestinal endoscopy 2013-11, Vol.78 (5), p.711-721
• Main Authors: Romero-Castro, Rafael, MD, PhD, Ellrichmann, Mark, MD, Ortiz-Moyano, Carlos, MD, PhD, Subtil-Inigo, Jose Carlos, MD, PhD, Junquera-Florez, Felix, MD, Gornals, Joan B., MD, Repiso-Ortega, Alejandro, MD, Vila-Costas, Juan, MD, PhD, Marcos-Sanchez, Francisco, MD, Muñoz-Navas, Miguel, MD, PhD, Romero-Gomez, Manuel, MD, Prof, PhD, Brullet-Benedi, Enric, MD, Romero-Vazquez, Javier, MD, Caunedo-Alvarez, Angel, MD, Pellicer-Bautista, Francisco, MD, PhD, Herrerias-Gutierrez, Juan M., MD, Prof, PhD, Fritscher-Ravens, Annette, MD, Prof, PhD
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; Cyanoacrylates - therapeutic use; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Endosonography - methods; Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - therapy; Female; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemostasis, Endoscopic - methods; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional - methods
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.05.009

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.