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Updated: Jul 25, 2025

Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
EUS-guided treatment of bleeding peristomal varices (with video)
Yara Sarkis1, Howard Masuoka1, Marwan Ghabril1
1Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA.
Background And Aims:
The use of EUS for peristomal varices (PV) is limited to case reports.
Methods:
Patients who underwent EUS-guided treatment of PV with cyanoacrylate (CYA) and/or coils between April 2013 and December 2019 were identified. All patients had failed previous therapies or had comorbidities precluding other options. Endoscopic technique, adverse events (AEs), recurrent bleeding, and repeat interventions were assessed.
Results:
Twenty patients (12 men; median age, 62 years [interquartile range {IQR}, 54.8-69.5]) underwent initial EUS-guided PV injection of CYA for secondary (n = 19) or primary (n = 1) prophylaxis. Within 30 days, AEs occurred in 11 patients (55%), of which 8 were mild. During a median 2.5 months (IQR, 2-8.5) of follow-up, confirmed (n = 6) or suspected (n = 2) PV bleeding recurred; 5 of 8 recurrences were retreated with CYA and/or coils without AEs. After retreatment, PV bleeding recurred in 2 patients a median of 6 months (IQR, 6-30) later.
Conclusions:
EUS appears to be a safe and promising technique for treatment of PV.
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