Endoscopic Ultrasound-Guided Variceal Therapy for Gastric Variceal Rupture After Failed Endoscopic Injection...

Area of Science:

• Gastroenterology and Interventional Endoscopy
• Vascular Imaging and Interventions

Background:

• Endoscopic ultrasound (EUS) is crucial for visualizing mediastinal and abdominal vascular structures.
• EUS-guided variceal therapy (EUS-VT) is an emerging, albeit underused, treatment for gastric varices (GV).
• Conventional therapies often fail in complex GV cases, necessitating alternative approaches.

Observation:

• A 63-year-old male with fatty liver cirrhosis experienced recurrent gastric variceal rupture despite multiple treatments.
• Standard endoscopic injection sclerotherapy (EIS) and other interventions were unsuccessful.
• EUS-VT was attempted as a rescue therapy during a recent rupture episode.

Findings:

• A 23-gauge needle failed, but a 22-gauge needle with cyanoacrylate successfully achieved varix puncture and obliteration under EUS guidance.
• Doppler imaging confirmed successful embolization with no observed blood flow.
• The patient experienced no adverse events or rebleeding during one-month follow-up.

Implications:

• EUS-VT is a viable rescue therapy for refractory gastric variceal bleeding, especially with complex anatomy.
• It offers precise targeting and real-time visualization, overcoming limitations of conventional EIS.
• Consider EUS-VT for patients unresponsive to standard treatments due to anatomical challenges.