868 Coils and Dermabond: A Large County Hospital Experience With Gastric Varices

Abstract

INTRODUCTION: Bleeding from gastric varices (GV) is associated with high mortality and morbidity. EUS-guided injection of coils, cyanoacrylate glue or both is an emerging modality for treatment of gastric varics. We present our experience using EUS injection of coils (Nester Embolization Coil; Cook Medical) and 2-Octyl-cyanoacrylate (Dermabond) glue in the treatment of bleeding gastric varices in a large county hospital setting. METHODS: Medical records of consecutivepatients undergoing EUS guided treatment of gastric varices with glue and coils between mth/yer to mth/year were reviewed.Patient characteristics were recorded including presence of cirrhosis, variceal characteristics (size, location), and intervention type. Outcomes included technical success (defined as deployment of glue and coils inside the varix with cessation of blood flow on Doppler evaluation), rebleeding events, and subsequent one month follow up were recorded. RESULTS: Total of 16 patients were treated with EUS guided injection of coils and/or glue. Three (18.8%) had active bleeding and four (25%) had stigmata of recent bleeding at the index endoscopy. The remaining 9 (46.2%) had history of bleeding from gastric varices. 15/16 patients were treated with both coils and glue injection. One patient with small varices was treated with glue injection alone. Technical success was achieved in all 16 (100%) patients. None of the patients had active bleeding at the end of the procedure. The mean number of coils inserted was 3.9 and the mean volume of glue injected was 2.1 mL. Rebleeding, defined as having repeat endoscopy for gross gastrointestinal bleeding, occurred in 3 patients within one month of the initial EUS. In one patient, rebleeding was from gastric varices and was again treated with coils and glue injection. There were no significant adverse events including pain or embolization of glue or coils. One patient had extrusion of coils into the lumen of the stomach with no active bleeding identified. CONCLUSION: In this series, we demonstrate the high technical success and efficacy of EUS guided coil and glue injection in treatment of bleeding or secondary prophylaxis of gastric varices.