eus引导下线圈消融治疗胃静脉曲张

Q3 Medicine

VideoGIE Pub Date : 2025-03-01 DOI:10.1016/j.vgie.2025.02.010

Davekaran Buttar MBBS, Mayank Goyal MBBS, Ashwariya Ohri MBBS, Andrew C. Storm MD, Eric J. Vargas Valls MD, MS, Michael A. McIntyre AEA, Barham Abu Dayyeh MD, MPH, FASGE

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引用次数: 0

摘要

背景和目的胃静脉曲张比食管静脉曲张有更高的出血和死亡风险。标准治疗，包括内窥镜注射氰基丙烯酸酯和球囊逆行经静脉闭塞，对卵圆孔未闭患者有动脉栓塞的风险。该病例强调了eus引导下线圈栓塞作为一种替代方法的使用。方法1例80岁男性，伴有肝硬化、胃食管静脉曲张、心房颤动、2型糖尿病和冠状动脉疾病，上消化道出血。内窥镜检查显示胃食管静脉曲张伴活动性出血。经胸超声心动图和气泡研究证实卵圆孔未闭，增加了内窥镜下氰基丙烯酸酯或球囊逆行经静脉闭塞栓塞的风险。考虑到经颈静脉门静脉分流术的禁忌症，我们采用eus引导下的线圈栓塞术。结果10个eus引导的Nester线圈放置至多普勒血流停止。术后内窥镜检查证实止血，血红蛋白水平稳定。随访内镜检查未见活动性出血及胃静脉曲张收缩。患者病情稳定，术后5天出院。结论超声引导下线圈栓塞是治疗胃底静脉曲张的一种安全有效的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Management of gastric varices with EUS-guided coil ablation

Background and Aims

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.

Methods

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.

Results

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.

Conclusions

EUS-guided coil embolization is a safe and effective alternative for managing gastric varices in patients with high arterial embolization risk.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.