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    • The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices: Influence Statistics

      Expert Impact

      Concepts for whichthey havehas direct influence:Gastric varices,Portal hypertension,Secondary prophylaxis,Hypertension portal,Esophageal gastric,Embolization therapeutic,Primary prophylaxis,Endoscopic injection.

      Key People For Gastric Varices

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      #1
      Shiv Kumar Sarin
      chronic hepatitis liver failure portal hypertension
      #2
      Deepak Lahoti
      portal hypertension gastric varices percutaneous ethanol injection
      #3
      Nandguri S Murthy
      gastric varices endoscopic sclerotherapy precancerous lesions
      #4
      Uday K Makwana
      gastric varices portal hypertension prevalence natural
      #5
      Sanjay P Saxena
      gastric varices portal hypertension prevalence natural
      #6
      Makoto Hashizume
      esophageal varices endoscopic surgery laparoscopic splenectomy

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

      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.

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