The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices

Curr Gastroenterol Rep. 2021 Jan 2;23(1):1. doi: 10.1007/s11894-020-00801-2.

Abstract

Purpose of review: Gastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation of obliteration with Doppler.

Recent findings: In this paper, we review treatments for GV involving EUS, including EUS-guided injection of CYA and coils, either alone or in combination. We also discuss less common methods, including EUS-guided injection of thrombin and absorbable gelatin sponge. We then review literature comparing EUS-guided methods with direct endoscopic therapy and comparing individual EUS-guided methods with one another. We conclude by highlighting drawbacks of EUS in this field, including the unproven benefit over conventional therapy, lack of a standardized approach, and limited availability of expertise and necessary materials. Novel EUS-based methods offer a unique opportunity to directly visualize and access gastric varices for treatment and obliteration. This may provide key advantages over current endoscopic or angiographic treatments. Comparative studies investigating the benefit of EUS over conventional therapy are needed.

Keywords: Coil injection; Cyanoacrylate injection; Endoscopic ultrasound; Gastric varices.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Embolization, Therapeutic
  • Endosonography*
  • Esophageal and Gastric Varices / diagnosis
  • Esophageal and Gastric Varices / diagnostic imaging*
  • Esophageal and Gastric Varices / etiology
  • Humans
  • Hypertension, Portal / complications
  • Injections, Intralesional
  • Tissue Adhesives / administration & dosage

Substances

  • Tissue Adhesives