Masuda Sakue, Irisawa Atsushi, Kubota Jun, Kobayashi Masahiro, Koizumi Kazuya
Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN.
Department of Gastroenterology, Dokkyo Medical University, Mibu, JPN.
Cureus. 2025 May 18;17(5):e84354. doi: 10.7759/cureus.84354. eCollection 2025 May.
Endoscopic ultrasound (EUS) has become an essential tool in vascular interventions due to its imaging potential in the proximity of various vascular structures in the mediastinum and abdominal cavity. EUS-guided variceal therapy (EUS-VT) has emerged as a promising approach for treating gastric varices (GV). Although still underused, EUS-VT offers such advantages as precise targeting and real-time variceal puncture visualization, making it a valuable alternative when conventional therapies fail. We report the case of a 63-year-old man with GVs secondary to fatty liver cirrhosis, who experienced repeated variceal ruptures despite multiple prior interventions (e.g., balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration, partial splenic embolization, and several endoscopic injection sclerotherapy (EIS) sessions). During his most recent variceal rupture episode, EUS-VT was performed. A 23-gauge sclerotherapy needle failed to reach the target varix under EUS guidance. However, successful puncture and obliteration could be achieved using a 22-gauge fine-needle aspiration needle and cyanoacrylate glue. Doppler imaging confirmed lipiodol distribution and the absence of blood flow, indicating successful embolization. No adverse events occurred or rebleeding was observed during the one-month follow-up. This case demonstrates the clinical utility of EUS-VT as a rescue therapy for gastric variceal bleeding in patients with anatomically complex lesions refractory to standard treatments. EUS-VT should be considered a viable option in selected cases when conventional EIS is unsuccessful due to anatomical limitations.
由于内镜超声（EUS）在纵隔和腹腔内各种血管结构附近具有成像潜力，它已成为血管介入治疗中的一项重要工具。EUS引导下的静脉曲张治疗（EUS-VT）已成为治疗胃静脉曲张（GV）的一种有前景的方法。尽管EUS-VT仍未得到充分应用，但它具有精确靶向和实时可视化静脉曲张穿刺等优点，当传统治疗失败时，它是一种有价值的替代方法。我们报告了一例63岁患有脂肪肝性肝硬化继发GV的男性病例，尽管此前进行了多次干预（如球囊闭塞逆行静脉栓塞术、经皮经肝闭塞术、部分脾栓塞术以及多次内镜注射硬化疗法（EIS）），但仍反复发生静脉曲张破裂。在他最近一次静脉曲张破裂发作期间，进行了EUS-VT治疗。在EUS引导下，一根23号硬化治疗针未能到达目标静脉曲张。然而，使用一根22号细针穿刺针和氰基丙烯酸酯胶水成功实现了穿刺和闭塞。多普勒成像证实了碘油分布且无血流，表明栓塞成功。在为期一个月的随访期间未发生不良事件，也未观察到再出血。该病例证明了EUS-VT作为标准治疗难治的解剖结构复杂病变患者胃静脉曲张出血的挽救治疗方法的临床实用性。当传统EIS因解剖学限制不成功时，在某些选定病例中应考虑将EUS-VT作为一种可行的选择。
