VideoGIE最新文献

{"title":"Tips on pre-emptive hemostasis of large vessels during endoscopic full-thickness resection of a large gastrointestinal stromal tumor","authors":"Abdullah Abbasi MD ,&nbsp;Maham Hayat MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Sagar Pathak MD ,&nbsp;Muhammad K. Hasan MD ,&nbsp;Kambiz K. Kadkhodayan MD ,&nbsp;Peter V. Draganov MD ,&nbsp;Dennis Yang MD","doi":"10.1016/j.vgie.2025.03.030","DOIUrl":"10.1016/j.vgie.2025.03.030","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Exposed endoscopic full-thickness resection is often necessary for the management of large subepithelial lesions or those extending deep into the GI wall. Despite advances in endoscopy, our toolbox for the prevention and management of bleeding from large vessels remains limited. This video case report demonstrates the successful removal of a large gastrointestinal stromal tumor in the fundus, with a focus on our endoscopic approach to the management of large peritoneal vessels.</div></div><div><h3>Methods</h3><div>An exposed endoscopic full-thickness resection procedure was performed using a needle-type and insulated tip electrocautery knife. Endoscopic ligation of blood vessels was performed using through-the-scope clips, whereas closure of the gastric wall defect was accomplished with over-the-scope suturing.</div></div><div><h3>Results</h3><div>An 82-year-man with multiple comorbidities was found to have gastric fundal gastrointestinal stromal tumor on computed tomography and confirmed on endoscopic ultrasound fine-needle aspiration. After multidisciplinary discussion, he was planned for endoscopic resection. Given the size of the lesion and exophytic component, exposed endoscopic full-thickness resection was performed. Large peritoneal feeding vessels were identified. For pre-emptive hemostasis, through-the-scope clips were used for ligation before vessel transection. This approach was effective and resulted in sufficient mechanical tamponade to permit adequate visualization for targeted intervention when bleeding ensued. The remainder of the lesion was subsequently dissected without any issues. Closure of the large full-thickness defect was achieved using the over-the-scope suturing system.</div></div><div><h3>Conclusions</h3><div>We present pre-emptive endoscopic hemostatic strategies when encountering large vessels. Innovation and development of dedicated devices are urgently needed to increase the efficiency and safety of these procedures as we continue to expand our therapeutic boundaries.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 349-352"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multistep approach for managing a complex esophageal perforation","authors":"Shiran Shetty DM,&nbsp;Dronamraju Sujay Prabhath MD,&nbsp;Balaji Musunuri DNB,&nbsp;Praveen M.C.S. MD,&nbsp;Abhay Mahajan MD,&nbsp;Santanu Mishra PharmD","doi":"10.1016/j.vgie.2025.03.029","DOIUrl":"10.1016/j.vgie.2025.03.029","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Esophageal perforation in adults is associated with significant morbidity and mortality, with optimal treatment approaches remaining debated. Outcomes are linked to timely diagnosis and appropriate interventions. Common therapeutic options, such as esophageal clips, stents, and suturing, may be ineffective for large perforations. We aimed to show the need for a multistep approach in dealing with difficult perforations.</div></div><div><h3>Methods</h3><div>An 85-year-old male presented with chest pain and dyspnea, following an endoscopic procedure. He was hemodynamically stable but had leukocytosis (14,400/μL). CT thorax confirmed esophageal perforation with right-sided hydropneumothorax. Due to poor performance status, surgery was deferred. Endoscopy revealed a 4-cm midesophageal perforation. A fully covered self-expandable metal stent (SEMS) was initially placed. However, the perforation persisted after SEMS removal. To address the defect, endoluminal vacuum therapy (ENDOVAC) was attempted using a modified ENDOVAC with sponge attached to a Ryle’s tube and connected to a negative pressure wound therapy device. The sponge was replaced every 3 days, with adjustments to match the defect size. Despite 4 ENDOVAC sessions and defect reduction, complete closure was not achieved. Definitive closure was achieved using a through-the-scope tack-and-suture device. Tacks were placed 5 to 10 mm from the defect margins, securing healthy tissue, and deployed using a push catheter in a zig-zag pattern for optimal coverage. Sutures were tightened sequentially to eliminate slack and ensure closure.</div></div><div><h3>Results</h3><div>Postprocedure, an oral gastrograffin study confirmed no leaks, and then he was resumed on oral feeds. Follow-up chest x-ray showed resolution of hydropneumothorax, with no complaints or adverse events reported.</div></div><div><h3>Conclusions</h3><div>This case demonstrates the successful management of a complex esophageal perforation using a multistep endoscopic intervention approach. Failure of defect closure using clips required use of a covered metal stent, endoscopic vacuum therapy, along with tack-and-suture device to achieve complete closure of defect.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 387-391"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique for a difficult postliver transplant anastomotic stricture","authors":"Pankaj Singh DM Gastroenterology,&nbsp;Vikas Singla DM Gastroenterology,&nbsp;Akash Goel DNB Gastroenterology,&nbsp;Muzaffar Rashid Shawl DNB Gastroenterology,&nbsp;Shahnawaz Bashir MD Radiodiagnosis","doi":"10.1016/j.vgie.2025.03.025","DOIUrl":"10.1016/j.vgie.2025.03.025","url":null,"abstract":"<div><h3>Background and Aims</h3><div>In cases of postliver transplant biliary stricture with double-duct anastomsis, double-duct stenting is absolutely necessary to preserve graft function.</div></div><div><h3>Methods</h3><div>We present a successful technique of percutaneous cholangioscopy-assisted rendezvous ERCP for difficult anastomotic stricture after failure of cholangioscopy-guided wire negotiation and percutaneous transhepatic biliary drainage.</div></div><div><h3>Results</h3><div>We achieved successful completion of biliary drainage through right anterior sectoral duct and right posterior duct stenting with subsequent dilatation of the stricture. There was resolution of the anastomotic stricture on follow-up.</div></div><div><h3>Conclusions</h3><div>Cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique is a reasonable option for a difficult post-transplant anastomotic stricture when conventional methods fail.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 402-405"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid endoscopic submucosal dissection and endoscopic full-thickness resection for R0 resection of T1 colonic adenocarcinoma","authors":"Rahul Karna MD ,&nbsp;Iman Afraz MBBS ,&nbsp;Juan C. Manivel MD ,&nbsp;Daniela Guerrero Vinsard MD ,&nbsp;Mohammad Bilal MD","doi":"10.1016/j.vgie.2025.03.026","DOIUrl":"10.1016/j.vgie.2025.03.026","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Malignant colorectal polyps limited to superficial submucosa can undergo endoscopic resection as a curative strategy. Endoscopic full-thickness resection (EFTR) allows en bloc resection of malignant polyps; however, the technique is challenging in lesions with submucosal invasion or those &gt;20 mm in size.</div></div><div><h3>Methods</h3><div>This original article and accompanying video reviews the technique for hybrid endoscopic submucosal dissection (ESD) and EFTR to allow R0 resection of T1 colonic adenocarcinoma.</div></div><div><h3>Results</h3><div>In the case example, ESD was performed to make a 35-mm lesion pliable. This step allowed the lesion to be pulled into the cap and complete en bloc resection using the full-thickness resection device.</div></div><div><h3>Conclusions</h3><div>The case highlights that hybrid ESD-EFTR technique is feasible and allows for en bloc removal of superficially invasive submucosal colon adenocarcinoma with lesions &gt;20 mm in size. Initial mucosal incision and partial submucosal dissection can make the lesions with underlying submucosal invasion pliable and hence amenable to full-thickness resection using a full-thickness resection device.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 376-379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multipoint adjustable traction for endoscopic submucosal dissection using a helix tack suturing system: a case series","authors":"Kambiz S. Kadkhodayan MD ,&nbsp;Shayan Irani MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Sagar Pathak MD ,&nbsp;Abdullah Abbasi MD ,&nbsp;Maham Hayat MD ,&nbsp;Muhammad K. Hasan MD ,&nbsp;Dennis Yang MD","doi":"10.1016/j.vgie.2025.03.001","DOIUrl":"10.1016/j.vgie.2025.03.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Optimal exposure of the submucosal plane is essential for effective endoscopic submucosal dissection (ESD). The application of traction improves visualization and resection efficiency, but most described techniques rely on nonadaptive single-point fixation.</div></div><div><h3>Methods</h3><div>We describe a novel multipoint, adjustable traction technique using the X-Tack Endoscopic Helix Tacking System. Three tacks are placed around the lesion margin, and a fourth tack is secured to the contralateral wall of the colon. By pulling on the polypropylene suture, upward, multipoint traction or “parachuting effect” was achieved. This resulted in lesion stability and improved submucosal exposure during colorectal ESD.</div></div><div><h3>Results</h3><div>The traction technique was successfully applied in 3 patients.</div></div><div><h3>Conclusions</h3><div>Multipoint adjustable traction using the helix tack system resulted in improved submucosal visualization, lesion stability, and adaptability during ESD. Further research is needed.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 372-375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coagulation forceps-sparing techniques for pre-emptive sealing of blood vessels during third-space endoscopy","authors":"Zaheer Nabi MD, DNB, FASGE, FISG, FSGEI,&nbsp;Pradev Inavolu MD, DM,&nbsp;Rajesh Goud PhD,&nbsp;Santhosh Darisetty MD,&nbsp;D. Nageshwar Reddy MD, DM","doi":"10.1016/j.vgie.2025.03.002","DOIUrl":"10.1016/j.vgie.2025.03.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Intraprocedural bleeding is a significant concern during third-space endoscopy, particularly in procedures like peroral endoscopic myotomy and endoscopic submucosal dissection. Although coagulation forceps can be used to effectively manage large blood vessels, their use necessitates frequent instrument exchanges, disrupting procedural flow and increasing costs. This review describes several distinct coagulation techniques to achieve coagulation without the need for hemostatic forceps.</div></div><div><h3>Methods</h3><div>The following coagulation techniques were used: noncontact coagulation (SprayCoag E 5.5), saline immersion coagulation (SprayCoag E 5.5), contact coagulation with low-dose energy (PreciseSect E 0.9-1) or retracted tip of knife (SwiftCoag E 4), microwave coagulation using a bipolar device (10 W), and application of a novel self-assembling peptide (PuraStat).</div></div><div><h3>Results</h3><div>All the techniques effectively coagulated the blood vessels, with a low incidence of breakthrough bleeding and need for adjunctive hemostatic techniques reported. The transition from air to saline lowers impedance, thereby reducing voltage, which in turn diminishes the dissection effect while enhancing coagulation efficiency. The dissection power of SprayCoag and other coagulation modes (SwiftCoag or PreciseSect) could be adjusted by increasing the target distance or reducing the energy dose, respectively. Use of a novel bipolar device enables coagulation using microwave energy and application of self-assembling peptide gel minimizes the need for an electrosurgical unit for coagulation.</div></div><div><h3>Conclusions</h3><div>Several coagulation techniques effectively seal large blood vessels during submucosal dissection procedures, reducing reliance on hemostatic forceps. Further studies comparing these methods with conventional approaches are warranted to confirm their broader clinical applicability.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 380-385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic truncal vagotomy. Exploring the fourth space. A technical feasibility study in a porcine model","authors":"Kambiz Kadkhodayan MD ,&nbsp;Shayan Irani MD","doi":"10.1016/j.vgie.2025.02.012","DOIUrl":"10.1016/j.vgie.2025.02.012","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Surgical truncal vagotomy is an effective treatment for refractory hyperacidity syndromes but is associated with significant perioperative risk, high cost, and morbidity. Endoscopic truncal vagotomy and EUS-guided vagal modulation may offer a minimally invasive alternative. In our porcine study, we evaluated the technical feasibility of endoscopic truncal vagotomy and EUS-guided targeting of the vagus nerves.</div></div><div><h3>Methods</h3><div>A Yorkshire pig weighing 170 lbs was used for the study under an institutional review board–approved protocol. EUS was first used to identify both the anterior and posterior vagus nerves. The nerves were tattooed using a fine-needle aspiration needle. A mucosotomy, submucosal tunnel, and full-thickness myotomy were used to access the periesophageal adventitia. A tunnel was then created in the esophageal adventitia (fourth space), and the vagus nerve was identified and transected. After transection, the mucosotomy was closed using hemostatic clips. The procedure was repeated for the anterior and posterior vagus nerves. Postprocedure necropsy confirmed accurate EUS-guided tattoo placement, complete nerve transection, and we evaluated for intraprocedural adverse events.</div></div><div><h3>Results</h3><div>The procedure was technically successful, with stable intraoperative vitals noted. On necropsy, both the anterior and posterior vagus nerves were accurately tattooed and completely transected in the lower esophagus. No evidence of leaks, mediastinal injury, or adverse events was observed.</div></div><div><h3>Conclusions</h3><div>This study demonstrates technical feasibility of (1) EUS-guided vagus nerve identification and targeting using a fine-needle aspiration as needed, and (2) endoscopic transection of both the anterior and posterior vagus nerves. Controlled dissection, low carbon dioxide insufflation, and meticulous technique are essential for safety. Further research is needed to refine the technique, assess safety and efficacy, and explore its full clinical potential.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 340-344"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic management of candy cane syndrome with a lumen-apposing metal stent","authors":"Davekaran Buttar MBBS,&nbsp;Mayank Goyal MBBS,&nbsp;Ashwariya Ohri MBBS,&nbsp;Andrew C. Storm MD,&nbsp;Eric J. Vargas Valls MD, MS,&nbsp;Barham Abu Dayyeh MD, MPH, FASGE","doi":"10.1016/j.vgie.2025.02.008","DOIUrl":"10.1016/j.vgie.2025.02.008","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Candy cane (CC) or “hockey stick” syndrome is an adverse event of Roux-en-Y gastric bypass (RYGB) caused by an excessively long blind afferent limb distal to the gastrojejunostomy. This anatomical anomaly leads to symptoms such as pain, regurgitation, vomiting, and weight loss. Although surgical resection is the standard treatment, it is technically challenging and associated with significant risks. Alternative endoscopic approaches have been described in limited case reports.</div></div><div><h3>Methods</h3><div>We present a novel EUS-guided approach to managing CC syndrome. A 61-year-old man with a history of RYGB presented with abdominal pain, vomiting, and low-grade fever for 2 months. Upper GI fluoroscopy and endoscopy confirmed CC anatomy. Under EUS guidance, a 20-mm lumen-apposing metal stent was deployed to create an anastomosis between the blind limb and the Roux limb, restoring luminal continuity.</div></div><div><h3>Results</h3><div>The patient tolerated the procedure well and was able to resume oral intake postoperatively. At 4-month follow-up, symptoms had resolved, and endoscopic evaluation confirmed stent patency. At 6 months, the patient remained asymptomatic, and the stent was successfully removed. A patent jejunojejunostomy was confirmed with free flow of contrast between the blind limb and the Roux limb.</div></div><div><h3>Conclusion</h3><div>This case highlights a novel, minimally invasive endoscopic approach for CC syndrome. EUS-guided enteroenterostomy with lumen-apposing metal stent offers a safe and effective alternative to surgical resection, potentially reducing morbidity in patients with this under-recognized adverse event of RYGB.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 368-371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closure of esophageal perforation after stricture dilation with novel through-the-scope clip","authors":"Erica Loon DO ,&nbsp;Natalie Wilson MD ,&nbsp;Mohammad Bilal MD","doi":"10.1016/j.vgie.2025.02.011","DOIUrl":"10.1016/j.vgie.2025.02.011","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Perforation during dilation of a refractory stricture can be challenging to manage endoscopically due to the friable nature of the tissue. A dual approximation tissue clip (DAC) is a novel through-the-scope (TTS) closure device designed for endoscopic closure of mucosal defects. There is emerging literature on the use of DACs for closure of resection defects, but there is limited knowledge regarding their efficacy in managing an acute perforation. Here, we describe a patient who had an esophageal perforation after dilation for refractory esophageal stricture and underwent successful endoscopic closure with DACs.</div></div><div><h3>Methods</h3><div>A 61-year-old man with a history of Barrett’s esophagus complicated by refractory esophageal stricture was referred to us for dilation. Post-dilation inspection revealed a 1-cm defect in the distal esophagus consistent with esophageal perforation. Using the 2 independently operated jaws of 3 DACs, we approximated the edges of the defect and achieved closure. A stent was placed for secondary reinforcement.</div></div><div><h3>Results</h3><div>The patient remained hemodynamically stable throughout the procedure and was admitted to the intensive care unit for close monitoring. No adverse events were experienced, and the stent was removed on follow-up endoscopy 6 weeks later with no residual perforation or leak seen.</div></div><div><h3>Conclusions</h3><div>Endoscopic closure of acute perforation with TTS clips in patients with esophageal strictures is typically challenging due to the friable nature of tissue. The independently operated jaws of the DAC allow for more controlled tissue approximation. This function provided endoscopic closure of esophageal perforation in our case, proving DACs to be a useful addition to the armamentarium of endoscopists.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 337-339"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of gastric varices with EUS-guided coil ablation","authors":"Davekaran Buttar MBBS,&nbsp;Mayank Goyal MBBS,&nbsp;Ashwariya Ohri MBBS,&nbsp;Andrew C. Storm MD,&nbsp;Eric J. Vargas Valls MD, MS,&nbsp;Michael A. McIntyre AEA,&nbsp;Barham Abu Dayyeh MD, MPH, FASGE","doi":"10.1016/j.vgie.2025.02.010","DOIUrl":"10.1016/j.vgie.2025.02.010","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Gastric varices are associated with a greater risk of bleeding and mortality than esophageal varices. Standard treatments, including endoscopic cyanoacrylate injection and balloon retrograde transvenous obliteration, pose risks of arterial embolization in patients with a patent foramen ovale. This case highlights the use of EUS-guided coil embolization as an alternative approach.</div></div><div><h3>Methods</h3><div>An 80-year-old man with cirrhosis, gastroesophageal varices, atrial fibrillation, type 2 diabetes mellitus, and coronary artery disease presented with hemodynamically significant upper gastrointestinal bleeding. Endoscopy revealed gastroesophageal varices with active stigmata of bleeding. A transthoracic echocardiogram with a bubble study confirmed a patent foramen ovale, increasing the risk of embolization with endoscopic cyanoacrylate or balloon retrograde transvenous obliteration. Given contraindications to a transjugular intravenous portosystemic shunt, EUS-guided coil embolization was performed.</div></div><div><h3>Results</h3><div>Ten EUS-guided Nester coils were deployed until Doppler flow cessation was observed. Postprocedure endoscopy confirmed hemostasis, and hemoglobin levels stabilized. Follow-up endoscopy showed no active bleeding and shrinkage of gastric varices. The patient remained stable and was discharged 5 days postprocedure.</div></div><div><h3>Conclusions</h3><div>EUS-guided coil embolization is a safe and effective alternative for managing gastric varices in patients with high arterial embolization risk.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 353-354"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}