Division of Digestive Diseases, UCLA Vatche and Tamar Manoukian, Los Angeles, CA, USA.
, Los Angeles, USA.
Curr Gastroenterol Rep. 2021 Jan 2;23(1):1. doi: 10.1007/s11894-020-00801-2.
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.
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.
胃静脉曲张（GV）是门静脉高压的一个重要并发症，目前的治疗建议是使用β受体阻滞剂进行一级预防，以及经颈静脉肝内门体分流术（TIPS）治疗活动性出血或二级预防。直接内镜下注射氰基丙烯酸酯（CYA）胶已被研究，但存在一些缺点，包括对 GV 的内镜下特征描述有限，以及可能发生远端胶栓塞。为此，内镜超声（EUS）已被用于帮助 GV 的特征描述、实时观察治疗过程，并通过多普勒确认闭塞。
在本文中，我们综述了涉及 EUS 的 GV 治疗方法，包括单独或联合使用 EUS 引导下注射 CYA 和线圈。我们还讨论了一些不太常见的方法，包括 EUS 引导下注射凝血酶和可吸收明胶海绵。然后，我们回顾了比较 EUS 引导下方法与直接内镜治疗的文献，并比较了各个 EUS 引导下方法之间的差异。最后，我们强调了 EUS 在该领域的缺点，包括其对传统治疗的益处尚未得到证实、缺乏标准化方法以及专业知识和必要材料的有限可用性。新型的基于 EUS 的方法为直接可视化和治疗胃静脉曲张提供了独特的机会，并可能提供优于目前的内镜或血管造影治疗的关键优势。需要进行比较 EUS 与传统治疗的疗效的研究。
