EUS-guided treatment of bleeding peristomal varices (with video)

Yara Sarkis; Howard Masuoka; Marwan Ghabril; Aditya Gutta; Mohammad A Al-Haddad; John M DeWitt

doi:10.1016/j.gie.2023.06.026

EUS-guided treatment of bleeding peristomal varices (with video)

Gastrointest Endosc. 2023 Nov;98(5):843-847. doi: 10.1016/j.gie.2023.06.026. Epub 2023 Jun 28.

Authors

Yara Sarkis¹, Howard Masuoka¹, Marwan Ghabril¹, Aditya Gutta¹, Mohammad A Al-Haddad¹, John M DeWitt¹

Affiliation

¹ Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA.

PMID: 37385550
DOI: 10.1016/j.gie.2023.06.026

Abstract

Background and aims: The use of EUS for peristomal varices (PV) is limited to case reports.

Methods: Patients who underwent EUS-guided treatment of PV with cyanoacrylate (CYA) and/or coils between April 2013 and December 2019 were identified. All patients had failed previous therapies or had comorbidities precluding other options. Endoscopic technique, adverse events (AEs), recurrent bleeding, and repeat interventions were assessed.

Results: Twenty patients (12 men; median age, 62 years [interquartile range {IQR}, 54.8-69.5]) underwent initial EUS-guided PV injection of CYA for secondary (n = 19) or primary (n = 1) prophylaxis. Within 30 days, AEs occurred in 11 patients (55%), of which 8 were mild. During a median 2.5 months (IQR, 2-8.5) of follow-up, confirmed (n = 6) or suspected (n = 2) PV bleeding recurred; 5 of 8 recurrences were retreated with CYA and/or coils without AEs. After retreatment, PV bleeding recurred in 2 patients a median of 6 months (IQR, 6-30) later.

Conclusions: EUS appears to be a safe and promising technique for treatment of PV.