[Obliteration of Gastric Varices using Endoscopic Ultrasound with Endocoils, with or without Cyanoacrylate. A Case series].

Abstract

Introduction: Gastric varices affect between 17% and 25% of patients with portal hypertension, and bleeding is a serious complication with high mortality. Although the standard treatment has been direct injection of cyanoacrylate by endoscopy, this can cause significant adverse effects in the patient and even damage to the endoscopic equipment. Therefore, this study describes the experience in managing gastric varices using endocoils, with or without cyanoacrylate, guided by endoscopic ultrasound.

Material and methods: A series of cases of patients with gastric varices treated with endocoil insertion, with or without cyanoacrylate injection, guided by endoscopic ultrasound, at two high-complexity institutions in Bogotá and Medellín, Colombia. The study period was from March 1, 2022, to July 31, 2024.

Results: Fifteen adult patients with gastric varices were included; 60% women, with a mean age of 63.3 years and a BMI of 29.1. 93% of the patients had chronic liver disease, mainly due to metabolic hepatic steatotosis or alcohol. IGV1 varices were observed in 10/15 patients and GOV2 varices in 5/15 patients, with an average variceal size of 15.1 mm. Between one and two endocoils were used per patient, and in six cases complementary cyanoacrylate was applied. The clinical success rate was 100% and the technical success rate was 93%. No serious complications were reported.

Conclusion: Treatment with EUS - guided endocoils, with or without cyanoacrylate injection under EUS guidance, is an innovative and effective technique, considered the treatment of choice for acute gastrointestinal bleeding and secondary prophylaxis in patients with GV. This case series showed high clinical and technical success rates, along with a low incidence of complications, suggesting that it is a safe procedure.