title: EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos).
abstract: BACKGROUND
  Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative.
  
  
  OBJECTIVE
  To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability.
  
  
  METHODS
  Retrospective analysis of a prospectively maintained database.
  
  
  METHODS
  Multicenter study, tertiary referral centers.
  
  
  METHODS
  Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment.
  
  
  RESULTS
  There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P < .01); only 3 were symptomatic, and an additional 9 (CYA group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding.
  
  
  CONCLUSIONS
  Nonrandomized; EUS expertise necessary.
  
  
  CONCLUSIONS
  EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data.
authors.affiliation: Service of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero-Castro
authors.forename: Mark
authors.initials: M
authors.lastname: Ellrichmann
authors.forename: Carlos
authors.initials: C
authors.lastname: Ortiz-Moyano
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Subtil-Inigo
authors.forename: Felix
authors.initials: F
authors.lastname: Junquera-Florez
authors.forename: Joan B
authors.initials: JB
authors.lastname: Gornals
authors.forename: Alejandro
authors.initials: A
authors.lastname: Repiso-Ortega
authors.forename: Juan
authors.initials: J
authors.lastname: Vila-Costas
authors.forename: Francisco
authors.initials: F
authors.lastname: Marcos-Sanchez
authors.forename: Miguel
authors.initials: M
authors.lastname: Muñoz-Navas
authors.forename: Manuel
authors.initials: M
authors.lastname: Romero-Gomez
authors.forename: Enric
authors.initials: E
authors.lastname: Brullet-Benedi
authors.forename: Javier
authors.initials: J
authors.lastname: Romero-Vazquez
authors.forename: Angel
authors.initials: A
authors.lastname: Caunedo-Alvarez
authors.forename: Francisco
authors.initials: F
authors.lastname: Pellicer-Bautista
authors.forename: Juan M
authors.initials: JM
authors.lastname: Herrerias-Gutierrez
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003487:Cyanoacrylates
keywords: B-RTO; CYA; ECA; EUS-guided coils application; GV; TIPS; balloon-occluded retrograde transvenous obliteration; cyanoacrylate; gastric varices; transjugular portosystemic shunt