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A review article on gastric varices with focus on the emerging role of endoscopic ultrasound-guided angiotherapy

Khoury, Tawfika,b; Nadella, Divyad; Wiles, Alexd; Marshall, Caitlind; Kumar, Manojd; Shapira, Giladd; Ludvik, Nicholasd; Schumann, Aland; Mahamid, Mahmudc; Mizrahi, Meird

European Journal of Gastroenterology & Hepatology: December 2018 - Volume 30 - Issue 12 - p 1411–1415
doi: 10.1097/MEG.0000000000001200
Review Articles

Background Gastric varices (GV) manifest in almost one-fifth of the patients with portal hypertension. Although primary pharmacological prevention of esophageal varices has been identified, there are limited therapeutic options that are optimal for GV bleeding. Recently, the use of endoscopic ultrasound (EUS)-guided angiotherapy [cyanoacrylate (CA) and coils] was introduced for the treatment of GV. Although CA injection is the recommended first-line therapeutic modality, it is associated with systemic, life-threatening embolization as well as technical instrumental challenges. Recently, EUS-guided coiling for GV was used with high safety profile.

Methods This is a review of the current literature on the treatment of GV, focusing on the role of EUS-guided angiotherapy in the treatment of GV. We performed a Medline/PubMed search, and 37 relevant studies were extracted and examined.

Results EUS-guided angiotherapy has shown a consistent favorable result among the several reports throughout the literature, with better safety and efficacy profile toward EUS-guided coiling; however, a combination treatment with EUS-guided coiling followed by glue injection has shown as well to reduce the embolization adverse events associated with glue injection.

Conclusion EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.

aDepartment of Internal Medicine

bLiver Unit, Department of Gastroenterology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem

cGastroenterology and Endoscopy United, The Nazareth Hospital, EMMS, Nazareth, Israel

dInternal Medicine Department, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, Alabama, USA

Correspondence to Tawfik Khoury, MD, The Liver Unit, Division of Internal Medicine, Institute of Gastroenterology and Liver Diseases, Hebrew University-Hadassah Medical Center, PO Box 12000, 91120 Jerusalem, Israel Tel: +972 509 870 611; fax: +972 4957 5832; e-mails: tawfikkhoury1@hotmail.com, taufick@hadassah.org.il

Received March 14, 2018

Accepted April 27, 2018

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