BACKGROUND AND AIMS:
Conventional endoscopic treatment of bleeding gastric fundal varices (GFV) with cyanoacrylate (CYA) glue may be complicated by embolization and re-bleeding. We evaluated the long-term outcomes of EUS-guided injection of coils and CYA glue for therapy of GFV.
A retrospective chart review of patients treated for GFV was performed. The main outcomes measured were: hemostasis, obliteration on surveillance EUS, re-bleeding rate, and adverse events.
152 patients with GFV were treated from March 2009-2015. Seven (5%) had active hemorrhage, 105 (69%) had recent bleeding and 40 (26%) were treated for primary prophylaxis. Treatment was technically successful in 151 (>99%). Mean number of coils was 1.4 (range 1-4 coils) and mean volume of CYA was 2 mL (range 0.5-6). 125 patients with treated GFV had follow-up available (mean 436 days; range 30-2043). Among 100 patients with follow-up EUS examinations, complete obliteration (on Doppler study) of GFV was confirmed in 93 (93%). Rebleeding from obliterated GFV occurred in 3 out of 93 patients (3%). Twenty-five patients who had clinical and/or EGD follow-up had 3 rebleeding episodes after a median follow-up of 324 days (41-486). Among the 40 patients treated for primary prophylaxis, 28 underwent follow-up EUS and 27 (96%) had confirmed obliteration. Mild post-procedure abdominal pain occurred in 4 out of 125 (3%),and clinical signs of pulmonary embolization were seen in 1 patient (1%). Another 4 of 125 (3%) presented with minor delayed UGI bleeding from coil/glue extrusion.
EUS-guided combined coil and CYA glue injection of high-risk GFV appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis. Once obliteration was achieved, re-bleeding from GFV occurred in only 3% during long-term follow-up. Combination therapy appears safe and may reduce the risk of CYA embolization.