Post written by Radhika Chavan, MD, DNB, FASGE, FISG, from Ansh Clinic, Ahmedabad, Gujarat, India.

In our article, we demonstrate the techniques of EUS-guided embolization of various vascular lesions, including gastric varices, ectopic varices, and pseudoaneurysms. We discuss 2 methods of EUS-guided embolization for gastric varices: (1) direct puncture of the varices and (2) feeder vessel embolization. The video highlights the precision and effectiveness of these techniques in achieving complete obliteration of the lesions using coils and cyanoacrylate, as evidenced by follow-up documentation.

EUS-guided embolization of gastric varices is a safe and effective technique that significantly reduces the rebleeding and reintervention rates compared with those of conventional gastroscopic techniques. Despite its widespread use, there is lack of standardization.

By showcasing EUS-guided embolization techniques, our video fills a critical knowledge gap, offering a step-by-step guide to effectively manage vascular lesions that often pose significant treatment challenges. The video provides essential information on the techniques to endoscopists, illustrating how to incorporate these methods into their practice to enhance patient outcomes.

Understanding the techniques and challenges encountered during therapy is crucial for optimizing outcomes and minimizing adverse events. From our experience, other endoscopists can learn the practical aspects and nuances of performing EUS-guided embolization, including selection of appropriate instruments and intricacies of each technique.

This article notes the importance of a thorough preprocedural assessment, selection of coil size based on varix size, precautions during glue injection, and scope and needle care following glue injection. It also underscores the need for a multidisciplinary setting to perform this procedure.

The article and video case contribute significantly to the body of knowledge on EUS-guided vascular interventions, emphasizing the need for continuous learning and adaptation of new techniques.

Various approaches of EUS-guided gastric variceal therapy. A, EUS-guided embolization of gastric varices via transesophageal (transmuscularis propria) approach: direct puncture of the varix and embolization technique. B, EUS-guided embolization of gastric varices via transgastric (trans-submucosal) approach by directly puncturing the varix. C, EUS-guided embolization of gastric varices by feeder vessel embolization via transesophageal (transmuscularis propria) approach.

Read the full article online.

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