El Dada A, El Khoury M, Stephan P, Nehme F. Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies. World J Gastrointest Endosc 2025; 17(12): 110168 [DOI: 10.4253/wjge.v17.i12.110168]
Corresponding Author of This Article
Fredy Nehme, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th Street, Indianapolis, IN 46202, United States. nehme.fredy@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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/
Dec 16, 2025 (publication date) through Dec 19, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
El Dada A, El Khoury M, Stephan P, Nehme F. Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies. World J Gastrointest Endosc 2025; 17(12): 110168 [DOI: 10.4253/wjge.v17.i12.110168]
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 110168 Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.110168
Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies
Anthony El Dada, Mandy El Khoury, Peter Stephan, Fredy Nehme
Anthony El Dada, Mandy El Khoury, Department of Medicine, University of Balamand, Beirut 100, Beyrouth, Lebanon
Peter Stephan, Department of Medicine, Saint George University of Beirut, Beirut 100, Beyrouth, Lebanon
Fredy Nehme, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Co-first authors: Anthony El Dada and Mandy El Khoury.
Author contributions: El Dada A, El Khoury M, and Stephan P performed the literature search and wrote the manuscript; Nehme F provided supervision and critical revision to the manuscript. El Dada A and El Khoury M contributed equally to this work as co-first authors.
Conflict-of-interest statement: The authors have no conflicts of interest relevant to 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: Fredy Nehme, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th Street, Indianapolis, IN 46202, United States. nehme.fredy@gmail.com
Received: June 3, 2025 Revised: June 24, 2025 Accepted: October 22, 2025 Published online: December 16, 2025 Processing time: 200 Days and 1.4 Hours
Abstract
Endoscopic ultrasound (EUS) guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists. Gastric variceal bleeding comprises 20% of all variceal bleeding and is associated with high morbidity and mortality. Historically, endoscopic injection of thrombosis-inducing agents such as glue has been used. However, glue injection carries potential risks including systemic embolization, damage to the endoscope, and recurrent bleeding. The introduction of hemostatic coils has revolutionized the endoscopic approach, with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices (GVs). When compared with conventional glue injection, EUS-guided embolization is associated with improved visualization, higher efficacy, and better safety profile. Despite its expanding adoption, the standardization of EUS guided embolization remains a challenge. High-quality studies are needed to standardize this promising technique and define its role in clinical practice. In this review, we will discuss the indications, efficacy, techniques, and various approaches for EUS-guided embolization of GVs.
Core Tip: Endoscopic ultrasound (EUS)-guided vascular interventions have changed the treatment landscape of gastric varices, providing a safer, more effective alternative to conventional glue injection. EUS-guided coil embolization improves visualization, provides higher efficacy and is associated with fewer complications including systemic embolization and recurrent bleeding. Nevertheless, the procedure remains difficult to standardize, and high-quality data is lacking to inform and optimize the treatment approach. This review will discuss the indications, techniques and emerging role of EUS-guided embolization in the management of gastric variceal hemorrhage.
