Endoscopic ultrasound-guided endovascular treatment of gastric varices

Abstract

Gastric variceal bleeding is associated with a high mortality. Endoscopic cyanoacrylate injection is the standard therapy; however, recurrent bleeding and adverse events, such as injection site ulceration and distal embolization, are pitfalls of this therapy. Endoscopic ultrasound-guided treatment of gastric varices offers several possible advantages over current therapies. It allows for detailed assessment of the vascular anatomy, efficacy and safety similar to that of current therapies, and makes it possible to evaluate treatment effect through Doppler ultrasound. We review treatments for gastric varices, including endoscopic ultrasound-guided injection of cyanoacrylate and coils, either alone or in combination, injection of thrombin and absorbable gelatin sponge. The appropriate selection of patients for these procedures is paramount to ensure acquisition of useful clinical data and patient safety. We searched the literature in the MedLine database on the PubMed platform.

Keywords

• gastric varices
• review
• endoscopic ultrasound
• treatment