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Open AccessArticle

Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience

1
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
2
Department of Gastroenterology, Hospital of the Ministry of Internal Affairs in Szczecin, 70-382 Szczecin, Poland
3
Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1786; https://doi.org/10.3390/jcm8111786
Received: 29 September 2019 / Revised: 18 October 2019 / Accepted: 23 October 2019 / Published: 25 October 2019
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs is obliteration with cyanoacrylate (CYA). This study presents our experience with combined therapy (vascular coils and CYA) under endoscopic ultrasound (EUS) guidance. Methods: 16 patients (9 male and 7 female) were included into our study. Etiology of portal hypertension included: portal vein thrombosis (PVT) (31.0%), isolated splenic vein thrombosis (SVT) (25.0%), alcoholic cirrhosis (12.5%), hepatitis C cirrhosis (19.0%), and alcoholic cirrhosis with PVT (12.5%). Varices type GOV-2 were diagnosed in 8 patients, type IGV-1 and IGV-2 in 6 and 2 patients, respectively. Indications for treatment were based on endoscopic and endosonographic evaluations of GVs. Inclusion and exclusion criteria were also specified. Technique depended on the size of varices (different size of coils + CYA additionally). The results were based on the achievement of technical success, therapeutic effects, and number of adverse events. Average follow-up period was 327 days. Results: From January to August 2017, 16 patients were treated with EUS-guided obliteration of GVs using vascular coils only or coils with CYA injections. 6 (37.5%) and 10 (62.5%) patients underwent primary and secondary prophylaxis for hemorrhage, respectively. Technical success was achieved in 15 patients (94.0%). Mean numbers of implanted coils and CYA volume during one procedure were 1.7 and 2 mL, respectively. Therapeutic success was achieved in all patients treated with the combination. There were no serious complications such as embolization or death due to the procedure. Three patients (19.0%) had transient abdominal pain and two (12.5%) had transient fever. 1 patient had clinical symptoms of gastrointestinal bleeding. Conclusions: Based on our retrospective research we have concluded, that EUS-guided implantation of intravascular coils combined with cyanoacrylate injections is an effective method of treatment with an acceptable number of complications. View Full-Text
Keywords: gastric varices; endoscopic ultrasound; coil; cyanoacrylate; obliteration gastric varices; endoscopic ultrasound; coil; cyanoacrylate; obliteration
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MDPI and ACS Style

Kozieł, S.; Pawlak, K.; Błaszczyk, Ł.; Jagielski, M.; Wiechowska-Kozłowska, A. Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience. J. Clin. Med. 2019, 8, 1786. https://doi.org/10.3390/jcm8111786

AMA Style

Kozieł S, Pawlak K, Błaszczyk Ł, Jagielski M, Wiechowska-Kozłowska A. Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience. Journal of Clinical Medicine. 2019; 8(11):1786. https://doi.org/10.3390/jcm8111786

Chicago/Turabian Style

Kozieł, Sławomir; Pawlak, Katarzyna; Błaszczyk, Łukasz; Jagielski, Mateusz; Wiechowska-Kozłowska, Anna. 2019. "Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience" J. Clin. Med. 8, no. 11: 1786. https://doi.org/10.3390/jcm8111786

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