PDF(Pubmed)
Abstract：
Background: Although bleeding from gastric varices is less observed than esophageal variceal bleeding (VB) (25% vs. 64%), it is associated with an exceedingly high mortality rate of up to 45%. Current guidelines suggest that endoscopic cyanoacrylate injection therapy (ECI) is the first-line treatment for gastric variceal bleeding (GVB). A major concern, however, is the possibility of embolic incidents, which are clinically evident in approximately 1% of cases. There are no guidelines for secondary prophylaxis of GVB. Radiological treatments using a transjugular intrahepatic portosystemic shunt (TIPS) or balloon occlusive transvenous obliteration (BRTO) are considered viable. However, they are not universally inapplicable; for instance, in the setting of pulmonary hypertension (TIPS). EUS-guided combined injection therapy (EUS-CIT) (embolization coils + cyanoacrylate) is an emerging procedure with a perceived reduced risk of systemic embolization. Case presentation: A patient with alcoholic liver cirrhosis was subjected to EUS-CIT as a secondary prophylaxis for GVB. He had three VB episodes of prior presentation treated by endoscopic band ligation (EBL) and ECI. Due to recurrent episodes of bleeding, he was referred to TIPS, but was considered contraindicated due to severe pulmonary hypertension. EUS-CIT was conducted with two embolization coils inserted into the varix, followed by an injection of 1.5 mL of cyanoacrylate glue. A 19 Ga needle, 0.035″ 14/70 mm coils, non-diluted n-butyl-caynoacrylate, and a transgastric approach were utilized. There were no immediate complications. Complete obliteration of the GV was observed in a follow-up endoscopy on day 30. Subsequent endoscopies in months three and six showed no progression of gastric varices. Conclusions: Our initial experience with EUS-CIT suggests that it can be successfully used as secondary prophylaxis for recurrent GVB.
摘要：
背景：尽管胃静脉曲张出血的发生率低于食管静脉曲张出血（VB）（25％vs.64%），它与高达45%的极高死亡率相关。目前的指南建议，内镜下氰基丙烯酸酯注射疗法（ECI）是胃静脉曲张破裂出血（GVB）的一线治疗方法。一个主要的问题，然而,是栓塞事件的可能性，在大约1％的病例中临床上很明显。没有关于GVB二级预防的指南。使用经颈静脉肝内门体分流术（TIPS）或球囊闭塞性经静脉闭塞术（BRTO）的放射学治疗被认为是可行的。然而,它们并非普遍不适用；例如，在肺动脉高压（TIPS）的背景下。EUS引导的联合注射疗法（EUS-CIT）（栓塞线圈+氰基丙烯酸酯）是一种新兴的方法，可降低全身栓塞的风险。病例介绍：一名酒精性肝硬化患者接受EUS-CIT作为GVB的二级预防。他有3次VB发作，通过内窥镜带结扎（EBL）和ECI治疗。由于出血反复发作,他被称为TIPS，但由于严重的肺动脉高压而被认为是禁忌的。EUS-CIT用两个栓塞线圈插入静脉曲张进行，然后注射1.5mL氰基丙烯酸酯胶。19Ga针，0.035英寸14/70毫米线圈，非稀释正丁基丙烯酸正丁酯，并采用经胃入路。没有立即出现并发症。在第30天的随访内窥镜检查中观察到GV完全消失。随后在第3个月和第6个月的内窥镜检查显示胃静脉曲张没有进展。结论：我们对EUS-CIT的初步经验表明，它可以成功地用作复发性GVB的二级预防。
