Endoscopic ultrasound-guided coil deployment with sclerotherapy for gastric varices
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CASE REPORT
Endoscopic ultrasound‑guided coil deployment with sclerotherapy for gastric varices Kenji Nakamura1,2 · Takeshi Okamoto2 · Yasutoshi Shiratori2 · Katsuyuki Fukuda2 Received: 5 July 2020 / Accepted: 29 September 2020 © Japanese Society of Gastroenterology 2020
Abstract We present a case of gastric varices (GV) in the fundus treated by endoscopic ultrasound (EUS)-guided coil deployment with sclerotherapy. A 46-year-old man with a previous history of fatty liver and obesity presented to the emergency department with abdominal pain. Contrast computed tomography (CT) showed chronic liver disease, splenomegaly, and GV. Esophagogastroduodenoscopy (EGD) showed GV in the fundus. Follow-up EGD 6 months later revealed an increase in GV diameter to over 20 mm. Balloon-occluded retrograde transvenous obliteration appeared difficult due to the small caliber of the gastrorenal shunt observed on contrast CT. We performed EUS-guided coil deployment with sclerotherapy. The coil was deployed using a 19-gauge needle under EUS and fluoroscopic guidance. Next, 5% ethanolamine oleate with contrast medium was injected into GV using a 22-gauge needle. GV was reduced without complications, and no GV growth or hemorrhage was observed during 8 months of follow-up. Keywords Endoscopic ultrasound · EUS-guided therapy · Gastric varices · Coil
Introduction The most widely used treatment options for gastric varices (GV) are endoscopic cyanoacrylate (CYA) injection, balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS) [1–3]. However, these procedures need advanced expertise and involve some clinical problems. Endoscopic CYA injection is most often performed for GV with active bleeding or stigmata of recent bleeding in the clinical setting, but may cause rare but fatal complications such as sepsis and embolization of the lungs, brain, and heart [4–7]. Although it depends on the facility, BRTO and TIPS are often performed in elective cases and/or cases of difficult or refractory endoscopic procedures. BRTO is difficult in cases without major shunts such as gastrorenal shunts and has been reported to cause exacerbate esophageal varices and ascites. TIPS is not * Kenji Nakamura [email protected] 1
Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5‑11‑13, Sugano, Ichikawa, Chiba 272‑8513, Japan
Department of Gastroenterology, St. Luke’s International Hospital, 9‑1 Akashicho, Chuo‑ku, Tokyo 104‑8560, Japan
2
indicated for cases of severe liver dysfunction and has been reported to lead to liver failure and hepatic encephalopathy. It is also not covered by insurance in Japan. Recent reports have shown the effectiveness and safety of endoscopic ultrasound (EUS)-guided treatment for GV [8–11]. However, there is no established standard method for EUS-guided treatment of GV. We present a case of successful EUS-guided coil deployment with sclerotherapy for the treatment of GV with an insufficient gastrorenal shunt.
Case report A 46-ye
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