Contrast Enhanced Endoscopic Ultrasound Guided Coil and Glue Injection for Bleeding Gastric/Ectopic Varices

ABSTRACT Background Direct targeting of feeder afferent vessel by coil/glue has been shown to be most effective endoscopic ultrasound (EUS) guided method of achieving gastric variceal obliteration. However, correct identification of feeder vessel with EUS is difficult and time-consuming. Methods Contrast enhanced EUS (CE-EUS) provides real time evaluation of vasculature and therefore, can help in accurate identification of afferent and efferent perforators. In this retrospective case series, we report our experience with CE-EUS guided combined coil and glue injection into perforating feeders of varices. Results Six patients (all males; age 28-52 years) with GV and one patient (48 year old male) with rectal varix underwent CE-EUS guided combined coil and glue injection into the perforating feeders. Afferent feeder vessel could be identified in all patients with variceal obliteration in all patients after one session of EUS guided combined injection. There has been no recurrent bleeding during the follow-up of 1-6 months. Conclusion CE-EUS guided injection of glue and coil at the level of perforating feeders in gastric or rectal varices seems to be effective and safe.