| Workshop 26(JGES・JSGE) |
| Sat. November 23rd 14:00 - 17:00 Room 12: Kobe International Conference Center Main Hall |
| EUS-guided injection of cyanoacrylate. A note of caution. | |||
| Rafael Romero-Castro1, Victoria Alejandra Jimenez-Garcia1, Pedro Hergueta-Delgado1 | |||
| 1University Hospital Virgen Macarena | |||
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| EUS-guided injection of cyanoacrylate, associated or not with coil deployment, has been reported to minimize the risk of glue embolism (GE) in the therapy of gastric varices (GV). In the following videos we present our experience about some aspects of the hemodynamic of GV, after injecting pure contrast through 19G needles during their therapy by EUS-guided coil deployment. First-video: Gastrorenal shunts displayed by EUS-guided injection of contrast. Second-video: High-blood flow being the contrast rapidly cleared out. Third-video: The contrast flows through 5 coils through the gastrorenal shunt towards the cava vein. Fourth-video: Clearance of contrast in spite of 4 coils deployed. Fifth-video: The blood flow is obstructed and contrast remains in the GV, except for several small drops that run through the coils. Sixth-video: shows a completely procedure. Two coils are deployed and though them contrast is fragmented into small drops and flows towards the gastrorenal shunt. After deploying more coils, a thick mesh is obtained and thromboses of GV is achieved without cyanocrylate injection. EUS-guided therapy of GV seems promising because of its accuracy and safety profile. Although it is postulated that the injection of cyanoacrylate without lipiodol is safe, there is no way to carry out asymptomatic GE if lipiodol and CT scans are not used. EUS-guided coil deployment without cyanoacrylate nullifies any risk associated to the glue injection in a high blood-flow system. |
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Index Term 1: EUS-guided angiotherapy Index Term 2: Gastric varices |
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