Associate Editor Mimi Canto, MD, MHS, FASGE, highlights this Original Article “EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos)” by Rafael Romero-Castro, MD, PhD,* Mark Ellrichmann, MD,* Carlos Ortiz-Moyano, MD, PhD, Jose Carlos Subtil-Inigo, MD, PhD, Felix Junquera-Florez, MD, Joan B. Gornals, MD, Alejandro Repiso-Ortega, MD, Juan Vila-Costas, MD, PhD, Francisco Marcos-Sanchez, MD, Miguel Muñoz-Navas, MD, PhD, Manuel Romero-Gomez, MD, Prof, PhD, Enric Brullet-Benedi, MD, Javier Romero-Vazquez, MD, Angel Caunedo-Alvarez, MD, Francisco Pellicer-Bautista, MD, PhD, Juan M. Herrerias-Gutierrez, MD, Prof, PhD, and Annette Fritscher-Ravens, MD, Prof, PhD. This article is featured in the November issue of GIE: Gastrointestinal Endoscopy.
*Drs. Romero-Castro and Ellrichmann contributed equally to this article.
This is the first direct, albeit nonrandomized, comparison of two potentially life-saving endoscopic therapies for gastric varices– EUS-guided glue (cyanoacrylate) injection and EUS-guided coil placement.
Although this was not a randomized controlled trial, it gives us some prospectively collected data (albeit retrospectively analyzed) on the efficacy (high for both groups) and safety of these endoscopic therapies. Most adverse events were asymptomatic.
Figure 8. Endoscopic (A) and EUS (B) images of gastric fundal varices before EUS-guided therapy. After EUS-guided deployment of 4 coils, gastric fundal varices obliteration was achieved. One month after coil deployment (4 coils) a partial extrusion of 1 coil (C) (arrow) is observed in the endoscopic view. D, EUS image of thrombosis of the gastric fundal varices and coils previously released.
EUS-guided glue injection and EUS-guided coiling (angiotherapy) require EUS and increase costs. Direct endoscopic glue injection, supported by RCTs and endorsed by AASLD guidelines, may still be first line, cheapest, most practical, and available therapy for most. There is a very nice accompanying editorial providing a good perspective and cautionary note. Bottom line is that we need comparative randomized controlled trials but these would be very difficult to do in acute gastric variceal bleeding therapy requiring EUS expertise.
Read this article on pages 711-722 of the print journal or find it online.
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