title: EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos).
abstract: BACKGROUND
  There have been numerous reports of glue embolization after endoscopic cyanoacrylate (CYA) glue treatment of gastric fundal varices (GFV), with some cases fatal. Coils with attached synthetic fibers may decrease or eliminate this risk and may decrease the amount of CYA needed to achieve obliteration.
  
  
  OBJECTIVE
  Assess the feasibility, safety, and outcomes of transesophageal EUS-guided therapy of GFV with combined coil and CYA injection.
  
  
  METHODS
  Retrospective query of a prospectively maintained database.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  Patients with hemorrhage from large GFV.
  
  
  METHODS
  A standardized approach by using EUS-guided coil and CYA treatment.
  
  
  METHODS
  Hemostasis, rebleeding rate, complications.
  
  
  RESULTS
  Thirty patients with GFV were treated between March 2009 and January 2011. At index endoscopy, 2 patients had active hemorrhage and 14 had stigmata of recent hemorrhage. EUS-guided transesophageal treatment of GFV was successful in all. Mean number of GFV treated was 1.3 per patient, and the mean volume of 2-octyl-CYA injected was 1.4 mL per varix. Hemostasis of acute bleeding was 100%. Among 24 patients with a mean follow-up of 193 days (range 24-589 days), GFV were obliterated after a single treatment session in 23 (96%). Rebleeding occurred in 4 patients (16.6%), with none attributed to GFV. There were no procedure-related complications and no symptoms or signs of CYA embolization.
  
  
  CONCLUSIONS
  Single-center, pilot study.
  
  
  CONCLUSIONS
  Transesophageal EUS-guided coil and CYA treatment of GFV is feasible and deserves further study to determine whether this novel approach can improve safety and efficacy over standard endoscopic injection of CYA alone.
authors: Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA. binmoek@sutterhealth.org
authors: Kenneth F
authors: KF
authors: Binmoeller
authors: Frank
authors: F
authors: Weilert
authors: Janak N
authors: JN
authors: Shah
authors: Jin
authors: J
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D003487:Cyanoacrylates / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate