EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)
Background and Aims Conventional endoscopic treatment of gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and rebleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV. Methods A retrospective chart r...
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| Veröffentlicht in: | Gastrointestinal endoscopy 2016-06, Vol.83 (6), p.1164-1172 |
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| description | Background and Aims Conventional endoscopic treatment of gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and rebleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV. Methods A retrospective chart review of patients treated for GFV was performed. The main outcomes measured were hemostasis, obliteration on surveillance EUS, post-treatment bleeding rate, and adverse events. Results From March 2009 to 2015, 152 patients with GFV were treated. Seven (5%) had active hemorrhage, 105 (69%) had recent bleeding, and 40 (26%) were treated for primary prophylaxis. Treatment was technically successful in 151 patients (>99%). Mean number of coils was 1.4 (range, 1-4 coils), and mean volume of CYA was 2 mL (range, 0.5-6). Follow-up was available for 125 patients with treated GFV (mean, 436 days; range, 30-2043). Among 100 patients with follow-up EUS examinations, complete obliteration (on Doppler study) of GFV was confirmed in 93 (93%). Post-treatment bleeding from obliterated GFV occurred in 3 of 93 patients (3%). Twenty-five patients who had clinical and/or EGD follow-up had 3 post-treatment bleeding episodes after a median follow-up of 324 days (range, 41-486). Among the 40 patients treated for primary prophylaxis, 28 underwent follow-up EUS and 27 (96%) had confirmed obliteration. Mild postprocedure abdominal pain occurred in 4 of 125 patients (3%), and clinical signs of pulmonary embolization were seen in 1 patient (1%). Another 4 of 125 patients (3%) presented with minor delayed upper GI bleeding from coil/glue extrusion. Conclusions EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, post-treatment bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization. |
| doi_str_mv | 10.1016/j.gie.2015.09.040 |
| format | Article |
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Todd, MD ; Kane, Steven D., BS ; Shah, Janak N., MD ; Hamerski, Chris M., MD ; Binmoeller, Kenneth F., MD</creator><creatorcontrib>Bhat, Yasser M., MD ; Weilert, Frank, MD ; Fredrick, R. Todd, MD ; Kane, Steven D., BS ; Shah, Janak N., MD ; Hamerski, Chris M., MD ; Binmoeller, Kenneth F., MD</creatorcontrib><description>Background and Aims Conventional endoscopic treatment of gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and rebleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV. Methods A retrospective chart review of patients treated for GFV was performed. The main outcomes measured were hemostasis, obliteration on surveillance EUS, post-treatment bleeding rate, and adverse events. Results From March 2009 to 2015, 152 patients with GFV were treated. Seven (5%) had active hemorrhage, 105 (69%) had recent bleeding, and 40 (26%) were treated for primary prophylaxis. Treatment was technically successful in 151 patients (>99%). Mean number of coils was 1.4 (range, 1-4 coils), and mean volume of CYA was 2 mL (range, 0.5-6). Follow-up was available for 125 patients with treated GFV (mean, 436 days; range, 30-2043). Among 100 patients with follow-up EUS examinations, complete obliteration (on Doppler study) of GFV was confirmed in 93 (93%). Post-treatment bleeding from obliterated GFV occurred in 3 of 93 patients (3%). Twenty-five patients who had clinical and/or EGD follow-up had 3 post-treatment bleeding episodes after a median follow-up of 324 days (range, 41-486). Among the 40 patients treated for primary prophylaxis, 28 underwent follow-up EUS and 27 (96%) had confirmed obliteration. Mild postprocedure abdominal pain occurred in 4 of 125 patients (3%), and clinical signs of pulmonary embolization were seen in 1 patient (1%). Another 4 of 125 patients (3%) presented with minor delayed upper GI bleeding from coil/glue extrusion. Conclusions EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, post-treatment bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2015.09.040</identifier><identifier>PMID: 26452992</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Cyanoacrylates - therapeutic use ; Embolization, Therapeutic - methods ; Endosonography ; Esophageal and Gastric Varices - therapy ; Female ; Gastric Fundus ; Gastroenterology and Hepatology ; Gastrointestinal Hemorrhage - prevention & control ; Gastrointestinal Hemorrhage - therapy ; Gastroscopy - methods ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgery, Computer-Assisted ; Surgical Equipment ; Tissue Adhesives - therapeutic use ; Treatment Outcome ; Young Adult</subject><ispartof>Gastrointestinal endoscopy, 2016-06, Vol.83 (6), p.1164-1172</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2016 American Society for Gastrointestinal Endoscopy</rights><rights>Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-7e4efba087555720ac89acc12332721de13e243a89c5fb76f6115ceb147d545e3</citedby><cites>FETCH-LOGICAL-c451t-7e4efba087555720ac89acc12332721de13e243a89c5fb76f6115ceb147d545e3</cites><orcidid>0000-0002-2153-3194</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016510715029557$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26452992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhat, Yasser M., MD</creatorcontrib><creatorcontrib>Weilert, Frank, MD</creatorcontrib><creatorcontrib>Fredrick, R. Todd, MD</creatorcontrib><creatorcontrib>Kane, Steven D., BS</creatorcontrib><creatorcontrib>Shah, Janak N., MD</creatorcontrib><creatorcontrib>Hamerski, Chris M., MD</creatorcontrib><creatorcontrib>Binmoeller, Kenneth F., MD</creatorcontrib><title>EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background and Aims Conventional endoscopic treatment of gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and rebleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV. Methods A retrospective chart review of patients treated for GFV was performed. The main outcomes measured were hemostasis, obliteration on surveillance EUS, post-treatment bleeding rate, and adverse events. Results From March 2009 to 2015, 152 patients with GFV were treated. Seven (5%) had active hemorrhage, 105 (69%) had recent bleeding, and 40 (26%) were treated for primary prophylaxis. Treatment was technically successful in 151 patients (>99%). Mean number of coils was 1.4 (range, 1-4 coils), and mean volume of CYA was 2 mL (range, 0.5-6). Follow-up was available for 125 patients with treated GFV (mean, 436 days; range, 30-2043). Among 100 patients with follow-up EUS examinations, complete obliteration (on Doppler study) of GFV was confirmed in 93 (93%). Post-treatment bleeding from obliterated GFV occurred in 3 of 93 patients (3%). Twenty-five patients who had clinical and/or EGD follow-up had 3 post-treatment bleeding episodes after a median follow-up of 324 days (range, 41-486). Among the 40 patients treated for primary prophylaxis, 28 underwent follow-up EUS and 27 (96%) had confirmed obliteration. Mild postprocedure abdominal pain occurred in 4 of 125 patients (3%), and clinical signs of pulmonary embolization were seen in 1 patient (1%). Another 4 of 125 patients (3%) presented with minor delayed upper GI bleeding from coil/glue extrusion. Conclusions EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, post-treatment bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Combined Modality Therapy</subject><subject>Cyanoacrylates - therapeutic use</subject><subject>Embolization, Therapeutic - methods</subject><subject>Endosonography</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Female</subject><subject>Gastric Fundus</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastrointestinal Hemorrhage - prevention & control</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Gastroscopy - methods</subject><subject>Hemostasis, Endoscopic</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Surgery, Computer-Assisted</subject><subject>Surgical Equipment</subject><subject>Tissue Adhesives - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks2O1DAQhC0EYoeFB-CCfFwOCbYTx2OQkNBq-ZFW4jDM2XKcTnDw2IOdDORReFucnYUDB05WS_WV2lWN0HNKSkpo82osBwslI5SXRJakJg_QhhIpikYI-RBtSBYVnBJxgZ6kNBJCtqyij9EFa2rOpGQb9OtmvyuG2XbQ4SmCng7gJxx6POg0RWtwP_tOO3zSeYCEf9jpKzbh0FqfCetHMJMNfiVMsC5h7TtsFu2DNnFxegI8uBleY42djgPgfbkrMfw8QrTgDeBwgogbvICOCV_d2Z_yNuHlU_So1y7Bs_v3Eu3f33y5_ljcfv7w6frdbWFqTqdCQA19q8lWcM4FI9pspTaGsqpigtEOaAWsrvRWGt63oukbSrmBltai4zWH6hJdnX2PMXyfIU3qYJMB57SHMCdFhSR1wxivs5SepSaGlCL06hjtQcdFUaLWRtSociNqbUQRqXIjmXlxbz-3B-j-En8qyII3ZwHkT54sRJXMXTSdjTlc1QX7X_u3_9DGWW-Ndt9ggTSGOfqcnqIqMUXUbj2J9SIoJ0zmwKrf79Wxaw</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Bhat, Yasser M., MD</creator><creator>Weilert, Frank, MD</creator><creator>Fredrick, R. Todd, MD</creator><creator>Kane, Steven D., BS</creator><creator>Shah, Janak N., MD</creator><creator>Hamerski, Chris M., MD</creator><creator>Binmoeller, Kenneth F., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2153-3194</orcidid></search><sort><creationdate>20160601</creationdate><title>EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)</title><author>Bhat, Yasser M., MD ; Weilert, Frank, MD ; Fredrick, R. Todd, MD ; Kane, Steven D., BS ; Shah, Janak N., MD ; Hamerski, Chris M., MD ; Binmoeller, Kenneth F., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-7e4efba087555720ac89acc12332721de13e243a89c5fb76f6115ceb147d545e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Combined Modality Therapy</topic><topic>Cyanoacrylates - therapeutic use</topic><topic>Embolization, Therapeutic - methods</topic><topic>Endosonography</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Female</topic><topic>Gastric Fundus</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastrointestinal Hemorrhage - prevention & control</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Gastroscopy - methods</topic><topic>Hemostasis, Endoscopic</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Surgery, Computer-Assisted</topic><topic>Surgical Equipment</topic><topic>Tissue Adhesives - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhat, Yasser M., MD</creatorcontrib><creatorcontrib>Weilert, Frank, MD</creatorcontrib><creatorcontrib>Fredrick, R. Todd, MD</creatorcontrib><creatorcontrib>Kane, Steven D., BS</creatorcontrib><creatorcontrib>Shah, Janak N., MD</creatorcontrib><creatorcontrib>Hamerski, Chris M., MD</creatorcontrib><creatorcontrib>Binmoeller, Kenneth F., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhat, Yasser M., MD</au><au>Weilert, Frank, MD</au><au>Fredrick, R. Todd, MD</au><au>Kane, Steven D., BS</au><au>Shah, Janak N., MD</au><au>Hamerski, Chris M., MD</au><au>Binmoeller, Kenneth F., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>83</volume><issue>6</issue><spage>1164</spage><epage>1172</epage><pages>1164-1172</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Background and Aims Conventional endoscopic treatment of gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and rebleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV. Methods A retrospective chart review of patients treated for GFV was performed. The main outcomes measured were hemostasis, obliteration on surveillance EUS, post-treatment bleeding rate, and adverse events. Results From March 2009 to 2015, 152 patients with GFV were treated. Seven (5%) had active hemorrhage, 105 (69%) had recent bleeding, and 40 (26%) were treated for primary prophylaxis. Treatment was technically successful in 151 patients (>99%). Mean number of coils was 1.4 (range, 1-4 coils), and mean volume of CYA was 2 mL (range, 0.5-6). Follow-up was available for 125 patients with treated GFV (mean, 436 days; range, 30-2043). Among 100 patients with follow-up EUS examinations, complete obliteration (on Doppler study) of GFV was confirmed in 93 (93%). Post-treatment bleeding from obliterated GFV occurred in 3 of 93 patients (3%). Twenty-five patients who had clinical and/or EGD follow-up had 3 post-treatment bleeding episodes after a median follow-up of 324 days (range, 41-486). Among the 40 patients treated for primary prophylaxis, 28 underwent follow-up EUS and 27 (96%) had confirmed obliteration. Mild postprocedure abdominal pain occurred in 4 of 125 patients (3%), and clinical signs of pulmonary embolization were seen in 1 patient (1%). Another 4 of 125 patients (3%) presented with minor delayed upper GI bleeding from coil/glue extrusion. Conclusions EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, post-treatment bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26452992</pmid><doi>10.1016/j.gie.2015.09.040</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2153-3194</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Combined Modality Therapy Cyanoacrylates - therapeutic use Embolization, Therapeutic - methods Endosonography Esophageal and Gastric Varices - therapy Female Gastric Fundus Gastroenterology and Hepatology Gastrointestinal Hemorrhage - prevention & control Gastrointestinal Hemorrhage - therapy Gastroscopy - methods Hemostasis, Endoscopic Humans Male Middle Aged Retrospective Studies Surgery, Computer-Assisted Surgical Equipment Tissue Adhesives - therapeutic use Treatment Outcome Young Adult |
| title | EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video) |
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