Puri Rajesh, Sharma Zubin Dev, Patle Saurabh, Bhagat Suraj, Kathuria Abhishek
Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Delhi, NCR, India.
Endosc Ultrasound. 2024 Jan-Feb;13(1):35-39. doi: 10.1097/eus.0000000000000038. Epub 2023 Dec 1.
In portal hypertension, gastric varix-associated bleeding is known to have higher transfusion requirements, uncontrolled bleeding, rebleeding, intensive care unit requirements, and death. EUS-guided coil insertion is now an acceptable modality for endoscopic management in cases of gastric varices. With this study, we discuss our large single-center experience in the use of EUS for coil and glue injection in gastric varices. We also look into adverse events associated with and possibilities of using this modality as both primary prophylaxis and a rescue therapy.
The study was conducted in a tertiary care center in India. A total of 86 patients were included in the study. The indication for EUS-guided coil and glue was divided into 3 clinical situations, namely, rebleed, rescue, and primary. The technical success and clinical success, that is, control of bleed in patients, were confirmed by absence of Doppler signal on EUS, endoscopic view, and stabilized hemoglobin with no need of blood product transfusion to maintain hemoglobin.
The mean Child-Turcotte-Pugh score and Model for End-Stage Liver Disease-Na score were 9.2 and 14.6, respectively. The mean size of the gastric varices was 18.9 mm. The mean number of coils used was 2.9, and the average quantity of glue required was 1.6 mL. The technical success was 100% across the patient group. Clinical success was seen in 90% of the patient group. Mean follow-up was seen for 175.2 days.
EUS-guided coil and glue therapy has a role in different clinical settings, as primary therapy, rebleed, and rescue therapy. It has significant technical and clinical success. Its role in treatment algorithms needs to be further studied in prospective studies. It may offer a cost advantage in comparison to interventional radiology-led interventions.
在门静脉高压症中，胃静脉曲张相关出血已知具有更高的输血需求、出血难以控制、再出血、重症监护病房需求以及死亡率。超声内镜引导下线圈置入术目前是胃静脉曲张内镜治疗中可接受的一种方式。通过本研究，我们讨论了我们在一家大型单中心使用超声内镜进行胃静脉曲张线圈和胶水注射的经验。我们还研究了与这种方式相关的不良事件以及将其用作一级预防和挽救治疗的可能性。
该研究在印度的一家三级医疗中心进行。共有86例患者纳入研究。超声内镜引导下线圈和胶水治疗的适应证分为3种临床情况，即再出血、挽救和一级预防。技术成功和临床成功，即患者出血得到控制，通过超声内镜检查无多普勒信号、内镜观察以及血红蛋白稳定且无需输血以维持血红蛋白水平来确认。
Child-Turcotte-Pugh评分和终末期肝病钠模型评分的平均值分别为9.2和14.6。胃静脉曲张的平均大小为18.9毫米。使用的线圈平均数量为2.9个，所需胶水的平均量为1.6毫升。整个患者组的技术成功率为100%。90%的患者组获得了临床成功。平均随访时间为175.2天。
超声内镜引导下线圈和胶水治疗在不同临床环境中可作为主要治疗、再出血治疗和挽救治疗发挥作用。它具有显著的技术和临床成功率。其在治疗方案中的作用需要在前瞻性研究中进一步探讨。与介入放射学主导的干预措施相比，它可能具有成本优势。
