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Updated: Jan 31, 2026

Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
A Technical Review of EUS-Guided Variceal Eradication
Andrew Canakis1, Kenneth F Binmoeller2, Todd H Baron1
1Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract:
Gastric varices present a unique therapeutic challenge for endoscopists. Although the use of direct endoscopic cyanoacrylate glue injection is superior to band ligation, it carries a risk of systemic adverse events. This led to the development of endoscopic ultrasound (EUS)-guided therapy. EUS enables accurate measurement and targeting of vessels, allowing for the precise intravascular delivery of cyanoacrylate and/or coils. Doppler imaging can be used to confirm obliteration in real time. In this review, we highlight recent literature on varying embolization techniques and detail the technical considerations required for a successful EUS-guided approach.
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