Khoury Tawfik, Nadella Divya, Wiles Alex, Marshall Caitlin, Kumar Manoj, Shapira Gilad, Ludvik Nicholas, Schumann Alan, Mahamid Mahmud, Mizrahi Meir
Department of Internal Medicine.
Liver Unit, Department of Gastroenterology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem.
Eur J Gastroenterol Hepatol. 2018 Dec;30(12):1411-1415. doi: 10.1097/MEG.0000000000001200.
Gastric varices (GV) manifest in almost one-fifth of the patients with portal hypertension. Although primary pharmacological prevention of esophageal varices has been identified, there are limited therapeutic options that are optimal for GV bleeding. Recently, the use of endoscopic ultrasound (EUS)-guided angiotherapy [cyanoacrylate (CA) and coils] was introduced for the treatment of GV. Although CA injection is the recommended first-line therapeutic modality, it is associated with systemic, life-threatening embolization as well as technical instrumental challenges. Recently, EUS-guided coiling for GV was used with high safety profile.
This is a review of the current literature on the treatment of GV, focusing on the role of EUS-guided angiotherapy in the treatment of GV. We performed a Medline/PubMed search, and 37 relevant studies were extracted and examined.
EUS-guided angiotherapy has shown a consistent favorable result among the several reports throughout the literature, with better safety and efficacy profile toward EUS-guided coiling; however, a combination treatment with EUS-guided coiling followed by glue injection has shown as well to reduce the embolization adverse events associated with glue injection.
EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.
胃静脉曲张（GV）在近五分之一的门静脉高压患者中出现。尽管已确定了食管静脉曲张的主要药物预防方法，但对于GV出血而言，最佳的治疗选择仍然有限。最近，内镜超声（EUS）引导下的血管内治疗（氰基丙烯酸酯和弹簧圈）被用于治疗GV。尽管注射氰基丙烯酸酯是推荐的一线治疗方式，但它会引发全身性、危及生命的栓塞，并且存在技术操作上的挑战。最近，EUS引导下的GV弹簧圈置入术安全性较高。
这是一篇关于GV治疗的当前文献综述，重点关注EUS引导下血管内治疗在GV治疗中的作用。我们进行了Medline/PubMed搜索，提取并审查了37项相关研究。
在整个文献中的几篇报告中，EUS引导下的血管内治疗均显示出一致的良好效果，与EUS引导下的弹簧圈置入术相比，安全性和有效性更高；然而，EUS引导下先进行弹簧圈置入再注射胶水的联合治疗也显示出可减少与胶水注射相关的栓塞不良事件。
EUS引导下的血管内治疗，特别是EUS引导下的弹簧圈置入术，是一种新兴的、有前景的技术，应被视为出血性GV的一线治疗选择。
