ENDOSCOPIC CYANOACRYLATE INJECTION 2.0: DOPPLER ENDOSCOPIC PROBE GUIDED TECHNIQUE FOR THE TREATMENT OF GASTRIC VARICES

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Endoscopic free hand injection of cyanoacrylate is generally used for gastric variceal obturation (GVO) but its limitations include the inability to objectively assess GVO. The Doppler Endoscopic Probe (DEP) is an FDA-cleared, non-endoscopic ultrasound (EUS), through the scope, doppler ultrasound probe that can be used by GI endoscopists without advanced endoscopic training to assess variceal flow before and after cyanoacrylate therapy. Herein, we present the outcomes of the largest US study to our knowledge of GVO using DEP from 2005 to 2020. Methods: This was a multicenter retrospective descriptive study of 110 patients from the years 2005-2020 who underwent endoscopic injection of cyanoacrylate glue for the treatment of GV. DEP was used to assess subsurface blood flow in varices and to titrate the volume of glue injectate based on blood flow. Undiluted n-butyl-2-cyanoacrylate was administered by rapid bolus injection directly into the gastric varix. Patients returned for surveillance endoscopies with glue injections based on a treatment protocol. The primary outcomes assessed were immediate hemostasis (bleeding stopped at index endoscopy) and durable hemostasis (no re-bleeding within one month). Secondary outcomes included complications, amount of glue injected, and the need for alternative treatments. Results: Of the 110 patients included in the study, 61% were male and 84% were caucasian. Eighty four percent had chronic liver disease with the most common etiology being alcohol-related. The two most common types of gastric varices were IGV1 (47%) and GOV2 (33%). 66 patients (60%) had more than 1 treatment session, with 31% having 4 or more. Our patients had an average of 3.4 endoscopy sessions total. Immediate hemostasis and durable hemostasis were achieved in 97% and 87% of the patients, respectively. The volume of glue used per session ranged from 0.5 ml to 7.5 ml with a mean of 2.45 ml and a standard deviation of 1.23. Complications occurred in 4 patients and included bleeding provoked by doppler probe (n=2), embolization (n=1), and sepsis (n=1). TIPS or BRTO was required in 7 patients (6%) for endoscopic treatment failure. Conclusion: The hybrid Doppler guided endoscopic free hand method is effective at achieving immediate and durable hemostasis and has rare serious adverse events. Importantly, the amount of glue used per session is notably lower (2.45 ml) compared to prior studies, which may explain the lower rates of embolization in our study. The immediate and durable hemostasis rates found in this study are comparable to that of TIPS, BRTO or EUS guided methods of GVO, which are complemented by the low rate of TIPS or BRTO for endoscopic treatment failure in our study. This simple non-EUS method allows endoscopists to safely and effectively treat bleeding gastric varices.

Volume

99

Issue

6

First Page

AB752

Last Page

AB752-AB753

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