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McKiernan, P. J.1; Baumann, U.1; Kelly, D. A.1; Wong, T.2
1The Liver Unit, Birmingham Children’s Hospital, Birmingham, 2Gastroenterology, St Thomas’s Hospital, London, United Kingdom
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Introduction: The best treatment for gastric variceal bleeding is unknown. Endoscopic injection of human thrombin is effective but definition of a therapeutic end point is difficult. Endoscopic ultrasound is better than videoendoscopy for detecting gastric varices and can monitor endotherapy. This combination however necessitates oesophageal re-intubation and dedicated equipment. Endoscopic ultrasound miniprobes (EUM) can be passed via the operating channel of a conventional videoendoscope. EUM can detect gastric varices but have not previously been used to monitor endotherapy.
Methods: Aim. To describe the novel use of EUM to monitor endotherapy of gastric varices
Results: Case report 1. A 13 year old girl with gastric variceal bleeding underwent endotherapy with human thrombin. Using a dual channel videoendoscope simultaneous imaging by an EUM applied to the varix confirmed opacification of the variceal lumen. At repeat examination 6 weeks later the variceal lumen remained opacified. After 9 months follow up she has had no further bleeding.
Case report 2. A 9 year old boy with gastric variceal bleeding underwent endotherapy with human thrombin on 2 occasions. Surveillance endoscopy 2 months later showed the gastric varix to be still present but simultaneous imaging with EUM confirmed ablation of the variceal lumen. Repeat endoscopy 6 months later showed involution of the gastric varix and he has had no further bleeding.
Conclusion: An endoscopic ultrasound miniprobe can be used to monitor endotherapy of gastric varices by human thrombin injection without the need for oesophageal re-intubation
© 2004 Lippincott Williams & Wilkins, Inc.
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