Abstract
balloon-occluding catheter must remain in position for several hours to allow maximal variceal sclerosis. An endoscopic-interventional radiologic approach that combines endoscopic cyanoacrylate injection with angiographic balloon occlusion of SRS to minimize the risk of glue embolism has been described.5 To our knowledge, his is the first report of such a procedure performed in the nited States, albeit with differences in technique, type of yanoacrylate used, and injection volume. SRS occlusion lso maximizes GV obturation by reducing variceal blood ow and allowing relative stasis, which facilitates glue olymerization. Unlike sclerosing agents, cyanoacrylate romotes prompt and effective obturation of GV6 without he adverse effects of large-volume sclerosant instillation. n addition, the balloon-occluding catheter can be reoved soon after variceal injection because GV solidificaion occurs rapidly. This technique seems to be a safe and ffective treatment for bleeding GV in patients with known Figure 3. Endoscopic appearance of obliterated fundal varices (confirmed by Doppler probe) at 1-month follow-up (arrow).
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