Manolakis A, Tsagkidou K, Koumarelas KE. Endoscopic ultrasound-guided therapies in the treatment of gastric varices: An in-depth examination of associated adverse events. World J Gastrointest Endosc 2024; 16(12): 640-646 [PMID: 39735397 DOI: 10.4253/wjge.v16.i12.640]
Corresponding Author of This Article
Anastasios Manolakis, MD, PhD, Assistant Professor, Department of Gastroenterology, University of Thessaly School of Medicine, Papakyriazi 22, Larisa 41100, Greece. manolakis@uth.gr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Anastasios Manolakis, Department of Gastroenterology, University of Thessaly School of Medicine, Larisa 41100, Greece
Kyriaki Tsagkidou, Department of Gastroenterology, General Hospital of Larisa, Larisa 41221, Greece
Konstantinos Eleftherios Koumarelas, Department of Emergency Medicine, General Hospital of Larissa, Larisa 41221, Greece
Author contributions: Manolakis A and Tsagkidou K participated equally in the conception, initial outline, drafting, revision and editing of the manuscript; Tsagkidou K and Koumarelas KE contributed to literature review; Koumarelas KE contributed to the conception, drafting, revision and editing of the manuscript; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anastasios Manolakis, MD, PhD, Assistant Professor, Department of Gastroenterology, University of Thessaly School of Medicine, Papakyriazi 22, Larisa 41100, Greece. manolakis@uth.gr
Received: August 6, 2024 Revised: October 1, 2024 Accepted: October 28, 2024 Published online: December 16, 2024 Processing time: 127 Days and 15.3 Hours
Abstract
The Baveno VII consensus, released in 2023, recommends that the endoscopic treatment of choice for managing bleeding gastric varices (GV) is endoscopic ultrasound (EUS)-guided treatment, specifically EUS-guided cyanoacrylate (CYA) glue injection. This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates, compared to other endoscopic techniques. Despite its efficacy, CYA injection for GV has been linked to rare but serious adverse events, such as glue embolization leading to pulmonary embolism, infection/bacteremia, splenic infarction, intra-procedural and post-procedural complications. The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance, aiming to more accurately direct the injection into the varix, reduce the volume of injected glue, target the perforating vein when possible, and confirm obliteration of GV via Doppler examination.
Core Tip: Gastric varices (GV), contribute to 10%-30% of upper gastrointestinal bleeding in patients with cirrhosis. GV account for 20% of variceal-related hemorrhage and are associated with higher risk of uncontrolled bleeding, transfusion needs, and mortality compared to esophageal varices. Recent studies have explored various endoscopic ultrasound (EUS)-guided therapies, such as cyanoacrylate injection and coil embolization. Albeit safe, EUS-therapies may expose patients to serious adverse events such as embolism, infection and bleeding. EUS-guided therapies often demonstrate superior efficacy in variceal obliteration and lower rebleeding rates compared to conventional methods. They come, however, with higher costs and technical challenges, such as precise needle placement and choosing between transgastric and transesophageal approaches.
