Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies

Figure 1 32-year-old male with history of cirrhosis secondary to alcohol use was referred for primary prophylaxis of gastric variceal bleeding. A: Upper endoscopy showed large type 1 isolated gastric variceal conglomerate; B: Endoscopic ultrasound showing a 3.7 cm variceal conglomerate; C: Trans-gastric deployment of coils through a 19-gauge needle; D: Endoscopic ultrasound showing thrombosis of targeted gastric varix; E: Follow-up endoscopy at 1 month showing smaller varices with cracked earth pattern suggesting obliteration; F: Absent flow on Doppler.

Figure 2 65-year-old female with history of metabolic dysfunction associated steatohepatitis cirrhosis presented with hematemesis and melena. A: Upper endoscopy showed large gastroesophageal varices type 2 with stigmata of recent bleeding; B: Endoscopic ultrasound (EUS) showing a large variceal conglomerate; C: The feeder vessel was located under EUS evaluation; D: Transesophageal deployment of multiple coils and absorbable gelatin sponge (Gelfoam slurry) under EUS guidance; E: Improvement in size of varices following EUS-guided coil embolization.

Figure 3 24-year-old male with history of portal vein thrombosis and hepatic encephalopathy was recently hospitalized with hematemesis and found to have gastric varices on upper endoscopy. Imaging showed no evidence of gastro-renal shunt. He was referred for endoscopic ultrasound (EUS) guided therapy of gastric varices. A: Upper endoscopy showing isolated gastric varices type 1; B: EUS showing complete thrombosis of varices following EUS guided coil embolization and cyanoacrylate glue injection; C: Coil extrusion on follow-up endoscopy at 3 months; D: Follow-up endoscopy at 1 year showing complete eradication of varices.