SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2015/10  
 
  2015 Oct pii: S0016-5107(15)02955-7  
  10.1016/j.gie.2015.09.040  
 
  EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)  
 
  Bhat YM, Weilert FF, Fredrick RT, Kane SD, Shah JN, Hamerski CM, Binmoeller KF  
  http://www.ncbi.nlm.nih.gov/pubmed/26452992  
 
 

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

 
Question posée
 
Est-il intéressant d’ajouter des coils au cyanoacrylate dans le traitement endoscopique des varices cardio-tubérositaires dans le but d’éviter les emboles et les récidives de saignement ?
 
Question posée
 
Étude rétrospective de 152 patients : traitement efficace avec un faible taux de re-saignement et 1% d’embolie pulmonaire.
 
Commentaires

Etude attirante mais réaliser dans 29% des cas chez des patients n’ayant jamais eu de saignement dont l’indication thérapeutique est donc discutable.

 
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