ENDOSCOPIC ULTRASOUND-GUIDED TREATMENT OF GASTRIC VARICES

Abstract

Bleeding from isolated gastric varices (iGV) is fatal. Thus, preventive treatment for iGV is crucial. The CA/EO method is a well-established endoscopic technique that has been used for the treatment of iGV; this technique uses a tissue adsorbent cyanoacrylate (CA) and a sclerosingagent, ethanolamine oleate (EO). In the recent years, a new technique of endoscopic ultrasound (EUS)-guided coil placement has shown promising results. This method enables safe and effective treatment because the puncture is performed while directly observing the iGV lumen with EUS and the coil (coil size is 150% of diameter of iGV)can be deployed with a needle under the guidance of the EUS. In this study, we performed EUS-guided coil deployment with sclerotherapy (EUS-CS), followed by the injection of EO after coil placement to embolize not only iGV but also the blood tract. This method is very effective, but it is necessary to evaluate and understand the hemodynamics of portal hypertension using various diagnostic imaging methods before treatment.