July 10, 2023
Expert treatment centers should consider performing certain endoscopic ultrasound -guided vascular interventions with current levels of supporting evidence, according to a practice update from the American Gastroenterological Association.
The update's authors, led by Marvin Ryou, MD, of Brigham and Women's Hospital, Boston, advised, when available, EUS-guided coil injection therapy of gastric varices over conventional direct endoscopic injection with cyanoacrylate glue, noting that EUS guidance"enhances the precision of injection," expands treatment options to include placement of hemostatic coils, and uses Doppler to provide real-time feedback on hemostasis.
Available evidence suggests that EUS-guided gastric variceal therapy is"safe, with excellent acute hemostasis and low re-bleeding rates, and likely superiority over traditional direct endoscopic glue injection," Dr. Ryou and colleagues wrote in their update.
EUS-guided direct measurement of the portosystemic pressure gradient may offer improved clinical efficiency over a percutaneous endovascular approach, Dr. Ryou and colleagues determined, notably when there is concern for a pre-sinusoidal cause of