1681 Achieving Hemostasis in a Gastric Tumor With Color Doppler-Endoscopic Ultrasound Guided Cyanoacrylate Glue

Abstract

INTRODUCTION: Up to 5 percent of upper gastrointestinal bleeds are due to tumors and re-bleeding is common. Most patients with severe hemorrhaging esophageal and gastric tumors have a poor prognosis, resulting in death within 1 year. Currently, there are no well-defined guidelines regarding the implementation of cyanoacrylate glue in bleeding gastrointestinal tumors. Our primary aim is to demonstrate a novel technique for achieving hemostasis in a tumor bleed. CASE DESCRIPTION/METHODS: A 63-year-old male with a past medical history of smoking, non-insulin dependent diabetes mellitus type 2, and hypertension presented with melena and early satiety. The patient denied the use of NSAIDS and alcohol. Evaluation by EGD demonstrated a gastric tumor with stigmata of recent hemorrhage in the form of a non-bleeding visible vessel. EUS was then used to locate this feeding vessel. Color doppler was then employed to confirm the target vessel and to subsequently guide the precise injection of cyanoacrylate glue into the vessel. The cessation of doppler flow after glue embolization confirmed hemostasis of the feeding blood vessel. During this procedure EUS-FNA was also utilized to extract a sample of tissue for diagnostic purposes with a 19-gauge needle. DISCUSSION: Color doppler-EUS guided cyanoacrylate glue injection is a cost-effective therapy that may successfully achieve hemostasis in tumor bleeds. It can be utilized to confirm hemostasis of the targeted vessel after embolization, during an endoscopic procedure. Endoscopic confirmation may reduce the likelihood of re-bleeding and additional procedures, thus, improving the quality of care. Watch the video: http://bit.ly/2M5YAE1.