A case of non-cirrhotic portal

hypertension complicated with

gastric varices treated with
endoscopic ultrasound (EUS)-guided
coil embolization
 K.S., male, age 74
•Addmited for melena, 3 weeks ago, in another medical service

•Clinical examination – hepatosplenomegaly

•Lab results

– Leucocitosis with neutrophilia

– No anemia

– Normal hepatic function

•Abdominal ultrasound

– Hepatosplenomegaly , perigastric collateral circulation

Upper gastrointestinal endoscopy
Gastric varices GOV 2
 EUS guided treatment with combined
injection of coil and Glubran in our case
 EUS guided treatment with combined
injection of coil and Glubran in our case
 Follow-up

• No clinical signs of re- bleeding

• Normal haemoglobin

• EUS – occluded flow by Doppler

• No need for a new endoscopic treatment session at that time

 Gastric varices treatment

De Franchis, R. (2015). Expanding consensus in portal hypertension. Journal of Hepatology, 63(3),

743–752. doi:10.1016/j.jhep.2015.05.022 
 Gastric varices treatment

Adverse effects of endoscopic therapy with tissue adhesive

• Embolism
•Hemorrhage from postinjection ulcers
•Fever
•Peritonitis
•Needle impaction
 Endoscopic ultrasound (EUS)-guided
puncture

Romero-Castro, R, Pellicer-Bautista, FJ, Jimenez-Saenz, M. EUS-guided injection of

cyanoacrylate in perforating feeding veins in gastric varices: results in 5
cases. Gastrointest Endosc 2007; 66: 402–407. 
 EUS-guided coil versus cyanoacrylate therapy

• Overall obliteration of the gastric varices was obtained for

96,7% of patients
Cyanoacrilate Coil
Number of
patients 19 11

Repeat therapy 10 3
Adverse effects 11 1
Hemostasis 19 11

Romero-Castro, R., Ellrichmann, M., Ortiz-Moyano, C., Subtil-Inigo, J. C., Junquera-Florez, F., Gornals, J. B., … Fritscher-
Ravens, A. (2013). EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study
(with videos). Gastrointestinal Endoscopy, 78(5), 711–721.
EUS-guided treatment of gastric fundal varices with
combined injection of coils and cyanoacrylate glue

Bhat, Y. M., Weilert, F., Fredrick, R. T., Kane, S. D., Shah, J. N., Hamerski, C. M., & Binmoeller, K. F.
(2016). EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate
glue: a large U.S. experience over 6 years (with video). Gastrointestinal Endoscopy, 83(6), 1164–1172.
 Take home messages

• EUS guided treatment for gastric varices is safer and should be

used more frequently in our medical centers

• Adding injection of coil to Glubran could decrease the adverse

effect rate and the reintervention rate

• Follow-up EUS is important to help us decide wheter the

treatment is effective or we need a new session