EUS-guided Therapy Research Articles

EUS-guided thrombin injection and coil implantation for gastric varices: feasibility, safety, and outcomes

Gastric varices (GVs) are reported in up to 20% of patients with portal hypertension, and bleeding is often more severe and challenging than esophageal variceal bleeding. Data are limited on prophylaxis of GV bleeding or management in the acute setting, and different techniques are used. This study evaluated outcomes after EUS-guided placement of coils in combination with thrombin to manage GVs. We retrospectively reviewed all patients treated with combination EUS-guided therapy with coils and thrombin between October 2015 and February2020. Twenty patients underwent 33 procedures for GV therapy; 16 of 20 (80%) had type 1 isolated GVs and 4 patients had type 2 gastroesophageal varices. The median follow-up was 842 days (interquartile range [IQR], 483-961). Seventeen patients (85%) had underlying cirrhosis, the most common etiologies being alcohol-related liver disease and nonalcoholic steatohepatitis. The median Child-Pugh score was 6 (IQR, 5-7). In 11 patients (55%), the indication was secondary prophylaxis to prevent recurrent bleeding; in 2 of 20 patients (10%), the bleeding was acute. Technical success was achieved in 19 patients (95%). During follow-up, the obliteration of flow within the varices was achieved in 17 patients (85%). The 6-week survival rate was 100%, and 2 adverse events, recurrent bleeding at day 5 and at day 37, were reported; both recurrent bleeding events were successfully managed endoscopically. EUS-guided GV obliteration combining coil placement with thrombin, in our experience, was technically safe with good medium-term efficacy. A multicenter randomized controlled trial comparing different treatment strategies is desirable to understand options better.

Recent Developments in the Field of Endoscopic Ultrasound for Diagnosis, Staging, and Treatment of Pancreatic Lesions.

Endoscopic ultrasound (EUS) plays a crucial role in the diagnosis of both solid and cystic pancreatic lesions and in the staging of patients with pancreatic cancer through its use for tissue and fluid sampling. Additionally, in cases of precancerous lesions, EUS-guided therapy can also be provided. This review aims to describe the most recent developments regarding the role of EUS in the diagnosis and staging of pancreatic lesions. Moreover, complementary EUS imaging modalities, the role of artificial intelligence, new devices, and modalities for tissue acquisition, and techniques for EUS-guided treatment are discussed.

EUS-guided therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis.

Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding. We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I2 % statistics. Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; I2 = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; I2 = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; I2 = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; I2 = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; I2 = 0), 95.5% (CI, 80.3%-99.1%; I2 = 0), and 88.7% (CI, 76%-95.1%; I2 = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; I2 = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; I2 = 31), 92.3% (CI, 81.1%-97.1%; I2 = 0), and 84.5% (CI, 50.8%-96.7%; I2 = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; I2 = 16) and 20.6% (CI, 9.3%-39.5%; I2 = 66), respectively. Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.

Endoscopic ultrasound-guided coiling and glue is safe and superior to endoscopic glue injection in gastric varices with severe liver disease: a retrospective case control study

Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV. A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared. In this study, the patients' age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation. EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

S1119 Safety and Efficacy of Pediatric Endosonography: A Multi-Center Retrospective Cohort Study

Introduction: Endoscopic ultrasound (EUS) is widely used in the adult population for a wide range of diagnostic and therapeutic purposes. In the pediatric population, the use of EUS has been historically diagnostic, however, EUS-guided therapy is increasing. In this retrospective study, we aim to describe the safety and efficacy profiles of EUS in pediatric patients across a spectrum of EUS procedures. Methods: This is a retrospective multi-center cohort study of pediatric patients who underwent EUS procedures for diagnostic or therapeutic purposes between January 2011 and March 2022. Data including demographics, procedural details, and adverse events (AE) were collected. Outcomes were diagnostic success, defined as successful diagnosis using only EUS without any additional diagnostic tools, and therapeutic success, defined as using only EUS without additional therapeutic interventions. Results: 61 pediatric patients between the age of 0 to 18 years underwent 77 EUS procedures, of which 35 were females (56.5%). The mean age at the procedure was 16.2 ± 4.2 years and the median weight was 70.2 kg (IQR 49.7-91.2). The indications for EUS were gastrointestinal lumen evaluation ± fine needle biopsy/aspiration (FNB/A), pancreaticobiliary tree evaluation ±FNB/A, surveillance for tumor syndrome, suspected lymph node (LN), or gastrointestinal (GI) mass, celiac plexus block and cyst gastrostomy creation (Table). The median procedure time was 35 minutes (IQR 18 – 49). The diagnostic success rate was 98.7% and the therapeutic success rate was 100%. The complication rate was 2.6% which included 2 cases of pancreatitis after fine-needle aspiration of the pancreas. No case had any anesthesia-related complications. Conclusion: In this multicenter retrospective cohort study, the use of EUS in pediatrics has shown to be safe and effective in a wide range of diagnostic and therapeutic intents. Table 1. - Baseline characteristics, procedural and clinical outcomes of pediatric patient EUS procedures N=77 (%) Females 35 (56.5) Weight (n=66) 70.2 [49.7 – 91.2] Age at procedure (years) 16.2 ± 4.2 Indication Diagnostic GI lumen Evaluation 9 (11.7) GI lumen Evaluation with FNB/A 5 (6.5) Pancreaticobiliary tree evaluation 37 (48.1) Pancreaticobiliary tree evaluation with FNB/A 6 (7.8) Surveillance for tumor syndrome 7 (9.1) Suspected LN or mass 8 (10.4) Therapeutic Celiac Plexus Block 1 (1.3) Cystgastrostomy 4 (5.2) Anesthesia Type Monitored Anesthesia Care (MAC) 48 (62.3) General Anesthesia 29 (37.7) Mean procedure Time in minutes (N= 59) 35.0 [18.0 - 49.0] Diagnostic Success 76 (98.7) Therapeutic Success (n=5) 5 (100) EUS related complications 2 (2.6) Anesthesia complications 0 (0) EUS = endoscopic ultrasound, FNA/B = fine needle aspiration/biopsy, LN = lymph node.Continuous variables presented as mean ± SD or median (IQR).Categorical variables presented as n (%).

Endoscopic ultrasound guided therapy of gastric varices: Initial experience in the Arab world (with video)

Background and objectivesGastric varices (GV) bleeding is a catastrophic complication of portal hypertension and is associated with significant morbidity and mortality. There are limited effective therapeutic interventions for the management of bleeding GV. Recently, EUS-guided therapy has been shown to be effective and safe intervention for such patients. However, there are no data to describe the feasibility and safety of EUS-guided therapy for GV in Arab population. The aim of this study is to describe our initial experience of EUS-guided therapy for GV in Kuwait.MethodsA case-series of patients that underwent EUS-guided therapy for clinically significant GV. All patients underwent EUS-guided therapy including Cyanoacrylate (CYA) injection with or without coil embolization. Patients were followed post procedure to document GV obliteration and monitor for any adverse events.ResultsIn total, 15 patients were included in this study (80% male) with mean age of 58 ± 12 years. The main indication for therapy was active GV bleeding (53.3%) followed by secondary prophylaxis (33.3%). Most patients had GOV-2 (80%) with mean GV size of 24.9 ± 7.9 mm. Combined EUS coil-CYA was used in most patients (80%), mean volume of CYA injected was 1.5 ± 0.74ml and mean number coils used of 1.5 ± 1.4. The technical success rate was 100% and all patients achieved GV obliteration after a median of 1 session (range 1-2). There were no major adverse events.ConclusionAmong Arab population with portal hypertension, EUS-guided therapy is highly effective and safe option for the managements of clinically significant GV.

State of the Art in Endoscopic Therapy for the Management of Gastroenteropancreatic Neuroendocrine Tumors.

Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) comprise a heterogeneous group of slow growing tumors arising from the neuroendocrine cells of the gastrointestinal (GI) tract. Although they are considered relatively rare, their incidence is rising and it is believed that the more frequent use of endoscopy and imaging studies have at least in part contributed to the increased diagnosis especially of localized neoplasms. The management of these neoplasms should be guided by a multidisciplinary NEN team following appropriate staging investigations. Localized neoplasms of the GI tract may be suitable for endoscopic therapy, while patients with pancreatic NENs, unsuitable for surgery, should be considered for endoscopic ultrasound (EUS)-guided ablation. In this review, we discuss the evidence regarding endoscopic resection of luminal NENs and EUS-guided therapy of pancreatic NENs. The efficacy, safety, and other longer-term outcomes of these techniques are summarized. In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs.

S1045 EUS-Guided Primary, Secondary Prophylaxis Treatment of Gastric Varices: A Systematic Review With Meta-Analysis

Introduction: Gastric varices (GV) increase the risk of gastrointestinal bleeding and carry a significant mortality risk, especially in the setting of portal hypertension. A major treatment modality for GV includes endoscopic ultrasound (EUS) guided glue and/ or coil injection. In this meta-analysis study, we aim to address the efficacy of EUS guided glue and/ or coil injection in the treatment of GV in primary and secondary prophylaxis. Methods: We conducted a comprehensive search of several databases including Medline, Scopus, Embase to identify studies from 2000-2019 that evaluated EUS guided therapy in the treatment of GV for primary and/or secondary prophylaxis. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, early re-bleeding, and late re-bleeding with EUS guided therapy of GV in primary and secondary prophylaxis. Calculation was done by standard meta-analysis methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. Results: A total of 13 studies were included in the final analysis. The EUS guided treatment efficacy of primary prophylaxis was 95% (95% CI [85.7-98.4%]) and secondary prophylaxis was 94.3% [83.6-98.1]. GV obliteration was 68.3% [43.4-85.8] for primary prophylaxis and 65.8% [38.8-85.4] for secondary prophylaxis. GV recurrence was 10% [2.5-32.8] in primary prophylaxis and 4.3% [1.7-10.5] in secondary prophylaxis. Early re-bleeding was seen in 6.7% [1.7-23.1] of primary prophylaxis cases and 5.5% [2.3-12.6] of secondary prophylaxis. Late re-bleeding was seen in 6% [2.3-14.9] of primary prophylaxis cases and 12.6% [9.3-16.8] of secondary prophylaxis cases. We conducted sub-group analysis with respect to studies published as abstracts and full manuscripts, and by sample-size. The results summarized in Table 1. Conclusion: Our meta-analysis study illustrates that EUS-guided therapy of GV may demonstrate excellent short and long-term clinical outcomes in both primary and secondary prophylaxis. This was shown by high EUS guided treatment efficacy of 95% and 94.3% in primary and secondary prophylaxis respectively. In addition, a low GV recurrence of 4.5% in secondary prophylaxis is a key positive finding; however, the late re-bleeding rate of 12.6% in secondary prophylaxis needs further evaluation and future study. Nevertheless, our study highlights that early EUS-guided therapy should be considered in the treatment of GV regardless of primary or secondary prophylaxis.Table 1.: Summary of pooled results

ID: 3520914 ENDOSCOPIC ULTRASOUND GUIDED THERAPY OF GASTRIC VARICES: INITIAL EXPERIENCE IN THE ARAB WORLD

Background and objectives: Gastric varices (GV) bleeding is a catastrophic complication of portal hypertension and is associated with significant morbidity and mortality. There are limited effective therapeutic interventions for the management of bleeding GV. Recently, EUS-guided therapy has been shown to be effective and safe intervention for such patients. However, there are no data to describe the feasibility and safety of EUS-guided therapy for GV in Arab population. The aim of this study is to describe our initial experience of EUS-guided therapy for GV in Kuwait.

International, multicenter retrospective trial comparing the efficacy and safety of bi-flanged versus lumen-apposing metal stents for endoscopic drainage of walled-off pancreatic necrosis.

BackgroundTo compare fully covered bi-flanged metal stents (BFMS) and lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainage/debridement of pancreatic walled-off necrosis (WON).MethodsPatients with WON managed by EUS-guided therapy were divided into those who underwent: 1) drainage using BFMS; and 2) drainage using LAMS and scheduled direct endoscopic necrosectomy (DEN). Clinical success (resolution of the WON), technical success (successful stent placement), and adverse events (AEs) were evaluated.Results387 patients underwent WON endoscopic drainage, 205 using BFMS and 182 using LAMS. The clinical success in the BFMS or LAMS groups were similar (197 [96.1%] vs. 174 [95.6%]; P=0.81). Median number of procedures required for WON resolution was significantly lower in BFMS compared to LAMS (2 vs. 3, P<0.001). Technical success for stent placement was similar in BFMS and LAMS groups (203 [99%] vs. 180 [99%], P=0.90). Procedure-related AEs were similar in the BFMS and LAMS groups (19 [9.3%] vs. 20 [10.9%], P=0.61). Stent dysfunction with occluding debris was higher in the BFMS group compared to LAMS group (21 [10.2 %] vs. 11 [5.9%], P=0.04). The migration rate was higher in the BFMS group than in the LAMS group (15 [7.3%] vs. 3 [1.6%]; P<0.001). DEN was required in 23 [11.2%] patients in the BFMS group after lack of WON resolution by conservative means.ConclusionBFMS with a “step-up approach” and LAMS with scheduled DEN are both safe and effective for EUS-guided drainage/debridement of WON.

Primary EUS-guided therapy of a giant visceral artery pseudoaneurysm: Expanding horizons (with video).

Primary EUS-guided therapy of a giant visceral artery pseudoaneurysm: Expanding horizons (with video).

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis.

Gastric variceal bleeding carries significant mortality in the setting of portal hypertension. Among the endoscopic treatment options, endoscopic ultrasound (EUS)-guided glue and/or coil injection is a novel approach, but its role in the treatment of gastric varices is not established due to a lack of robust data. We conducted a comprehensive search of several databases (inception to June 2019) to identify studies evaluating EUS in the treatment of gastric varices. Our primary goals were to estimate the pooled rates of treatment efficacy, obliteration and recurrence of gastric varices, early and late rebleeding, and adverse events with EUS-guided therapy in gastric varices. We also searched for studies that evaluated direct endoscopic glue (END-glue) injection for treatment of gastric varices, and used the pooled rates as comparators. 23 studies (851 patients) evaluating EUS-guided therapy were included. The pooled treatment efficacy was 93.7 % (95 % confidence interval [CI] 89.5 - 96.3, I 2 = 53.7), gastric varices obliteration was 84.4 % (95 %CI 74.8 - 90.9, I 2 = 77), gastric varices recurrence was 9.1 % (95 %CI 5.2 - 15.7, I 2 = 32), early rebleeding was 7.0 % (95 %CI 4.6 - 10.7, I 2 = 0), and late rebleeding was 11.6 % (95 %CI 8.8 - 15.1, I 2 = 22). The rates were comparable to END-glue therapy (28 studies, 3467 patients) except for obliteration, which was significantly better with EUS-guided therapy. On subgroup analysis, EUS-coil/glue combination showed superior outcomes. EUS-guided therapy demonstrated clinical efficacy for treatment of gastric varices in terms of obliteration, recurrence, and long-term rebleeding, and may be superior to END-glue.

EUS-guided therapy of gastric varices (with video).

EUS-guided therapy of gastric varices (with video).

Endoscopic Ultrasound-guided Gastroenterostomy: A Promising Alternative to Surgery.

Recently, with the advancement of techniques, endoscopic ultrasound-guided therapies have shown distinct advantages, especially in relieving benign and malignant gastric outlet obstruction (GOO), as well as in postoperative pancreaticobiliary diseases. Herein, we present five currently used approaches in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing biflanged metal stents (LAMS), along with several examples of LAMS-based EUS treatment of pancreaticobiliary diseases. Compared with traditional treatment methods, EUS-guided procedures have – to some degree – shown higher success rates, both technical and clinical. Moreover, EUS-guided therapies reduce the risk of multiple surgical adverse events, including delayed gastric emptying, prolonged hospital stay, increased costs, and delay in cancer treatment. Particularly in terms of postoperative pancreaticobiliary diseases, EUS-guided therapy has assumed an essential role as a treatment option in cases where traditional methods are difficult to perform. Nevertheless, EUS-guided gastrointestinal procedures are still relatively new, with some clinical failures, and additional prospective clinical trials are warranted.

904 EUS-Guided Treatment of Gastric Varices: A Systematic Review and Meta-Analysis With Indirect Comparison to Endoscopic Therapy

INTRODUCTION: Gastric variceal (GV) bleeding carries a significant mortality in the setting of portal hypertension. Emergency band ligation and/ or transjugular intrahepatic portosystemic shunt is the current recommended treatment. Other treatment options include direct endoscopic (END) glue injection and endoscopic ultrasound (EUS) guided glue and/ or coil injection. The role of EUS in the treatment of GV is not established and remains an active area of investigation. The aim of this study was to describe the performance of EUS in the treatment of GV. METHODS: We conducted a comprehensive search of several databases (inception to Dec 2018) to identify studies that evaluated END-glue and EUS in the treatment of GV. Our goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, early re-bleeding, late re-bleeding and adverse events with EUS guided therapy in GV. The pooled outcomes of END-glue was used as a comparator group. RESULTS: Total of 35 studies (2777 patients) were included. Mean age range was between 40 and 65 years, with 68% males. N-butyl-2-cyanoacrylate was the most commonly used glue. Use of lipiodol varied among the studies. 28% had GOV1, 48% had GOV2, and 24% had IGV1 (Sarin classification of GV). 63% of the patients had cirrhosis. 30% were due to alcohol and 31% due to viral hepatitis. 11% of the included patients had concomitant hepatocellular carcinoma. GV obliteration with EUS-guided therapy was 84.7% (95% CI 66.8-93.8, I2 = 84.2), and with END-glue was 57.1% (38.2-74.1, I2 = 94.3), P = 0.03. GV recurrence with EUS was 6.1% (95% CI 2.6-13.7, I2 = 51.4, and with END-glue was 22.6% (13.8-34.9, I2 = 77.1), P = 0.006. Late re-bleeding with EUS was 10.6% (95% CI 6.3-17.3, I2 = 45.7), and with END-glue was 20% (14.7-26.6, I2 = 89.30), P = 0.03. The pooled rates of immediate treatment efficacy and early re-bleeding were comparable. On subgroup analysis, EUS-coil/glue combination showed superior outcomes when compared to END-glue (Table 1). The pooled rate of overall adverse events with EUS-glue was 16.5% (9.7-26.9). The rates of adverse event subtypes, and how it compared to END-glue is given in Table 2. CONCLUSION: Based on our meta-analysis, EUS-guided therapies seems to demonstrate benefit in terms of GV obliteration, GV recurrence and late GV re-bleeding. They were significantly superior when indirectly compared to END therapy. The immediate treatment efficacy and early re-bleeding rates were comparable. EUS-coil/glue, in particular, seems to be the best modality.

2197 Successful EUS-Guided Treatment of Duodenal Varices With Coil Embolization

INTRODUCTION: Ectopic varices are unusual and can involve any site along the GI tract. Only 5% of variceal bleeding is related to ectopic varices such as duodenal varices. Ectopic variceal bleeding is usually massive, difficult to treat, and associated with high mortality rates. High clinical suspicion is warranted. No standardized treatment is recommended, and the management remains challenging with limited success in controlling recurrent bleeding. EUS-guided therapy has evolved as an effective therapeutic modality in gastric varices and this case demonstrates the role of EUS-guided coil embolization (EUS-CE) with cyanoacrylate (CYA) injection in the management of duodenal variceal bleeding. CASE DESCRIPTION/METHODS: 81-year-old female with history of Diffuse large B cell lymphoma on chemotherapy presented with intermittent massive upper gastrointestinal bleeding. CT abdomen showed cirrhotic liver and portal vein thrombosis due to lymphoma involvement. Three endoscopies performed over a period of 5 days revealed 1 cm non-bleeding duodenal ulcer at the duodenal sweep without stigmata of recent bleeding. Due to recurrent bleeding, empiric coil embolization of the gastroduodenal artery and multiple duodenal branches through angiography was done by interventional radiology. However, severe bleeding recurred after the embolization, and the fourth urgent EGD showed large subepithelial violaceous lesions next to the deep penetrating ulcer, highly suspicious for duodenal varices. EGD-EUS confirmed these lesions were duodenal varices. By the fifth day of admission, patient had required 8 units of PRBC. Therefore, the decision was made to treat with EUS-CE. Two coils of 8 and 9 mm were deployed into the larger varix through a 19G EUS-FNA needle followed by 2 ml injection of CYA. A third 6 mm coil was also deployed in the feeder vessel also followed by CYA. Both lead to embolization and cessation of blood flow as demonstrated through Doppler investigation at the end of the procedure. Bleeding stopped and patient was discharged home to complete chemotherapy. DISCUSSION: Bleeding from duodenal varices require high suspicion as vessels could be miss if collapsed soon after bleeding. High clinical suspicion can result in early angiographic evaluation and intervention. Ideal management of ectopic variceal bleeding is still unclear. Multiple endoscopic technique modalities have been reported. EUS-CE with or without CYA injection is a safe endoscopic technique with effective variceal obliteration in most cases.

Mo1528 – Comparison of Endoscopic and Ir Treatments of Gastric Varices: Eus-Guided Coil Therapy Has Decreased Reintervention and Re-Admission Rates Compared to Endoscopic Cyanoacrylate Injection, Brto, and Tips

Mo1528 – Comparison of Endoscopic and Ir Treatments of Gastric Varices: Eus-Guided Coil Therapy Has Decreased Reintervention and Re-Admission Rates Compared to Endoscopic Cyanoacrylate Injection, Brto, and Tips

Endoscopic Ultrasound (EUS)-Guided Therapy of Gastric Varices: A Systematic Review and Pooled Analysis

Introduction: Gastric varices (GV) contribute to high mortality in patients with advanced cirrhosis due to life-threatening bleeding and endoscopic management options are limited. Transjugular intrahepatic portosystemic shunt (TIPS) is commonly used in management of GV but poses several complications including worsening encephalopathy and may not be feasible in cases with portal vein thrombosis. Endoscopic ultrasound (EUS)-guided therapy with glue injection and/or coil placement is a novel method for treatment and eradication of GV. Our aim is to report the efficacy and safety of EUS-guided therapy for treatment of GV. Methods: A systematic review of existing literature on EUS-guided therapy was performed. Outcomes of interest were: pooled rates of technical success, clinical success as indicated by absence of early posttreatment bleeding (early 6 months), durable success rate (obliteration of varices confirmed by EUS), and procedure-related adverse events (pain, embolization, and bleeding within 120 hours). Pooled analysis was performed using the OpenMetaAnalyst software. Results: A total of 6 retrospective studies (263 patients with mean age 61.4 years, 64% males, 89% with cirrhosis) were analyzed. Active bleeding was noted in 12% on endoscopy, while 69% had stigmata of recent bleed. Average follow-up post endoscopy was 20.4 months. Technical success rate of the EUS-guided therapy was 99%. Clinical success was noted in 95.8%. EUS-guided therapy resulted in obliteration of GV in 80.3% of patients (95% CI: 64.5%-96.1%, I2 94.5%). Among patients with EUS confirmed obliteration of GV, 79% needed only a single EUS session. Among patients with EUS and/or clinical follow-up, recurrent bleeding from GV was observed in 9.3% (22/236, early 11, late 11). Of these, 50% underwent additional EUS-guided therapy successfully. Overall peri-procedural adverse event rate was 10%. The systemic embolization reported in 7% was asymptomatic and mostly associated with glue injection. There were no reported strokes. Only 1 death was directly attributed to the procedure. Conclusion: EUS-guided therapy of GV has high technical and clinical success rates with durability, and should be considered as an alternative to conventional endoscopic therapies and TIPS in carefully selected patients.

Eus-guided therapy for pancreatic pain: easy, effective and safe. why isn´t the first therapeutic approach?

Eus-guided therapy for pancreatic pain: easy, effective and safe. why isn´t the first therapeutic approach?

Future Perspectives on Endoscopic Ultrasonography-Guided Therapy for Pancreatic Neoplasm.

Endoscopic ultrasonography (EUS)-guided therapy with ethanol injection or catheter-based radiofrequency ablation for pancreatic neoplasm has been conducted as a potential alternate treatment modality for patients who are not eligible for surgery. On the basis of the limited number of studies available, EUS-guided ablation therapy with the aforementioned methods for small pancreatic neoplasms has demonstrated promising technical feasibility and safety profiles. To be considered as a legitimate alternative option to surgery, however, EUS-guided ablation therapy must provide a long-term efficacy profile along with the consensus among experts regarding its treatment parameter. This review focuses on the clinical issues and future perspectives of EUS-guided therapy for pancreatic neoplasm.