P-THER-12: Outcome of sequential treatment with endoscopic ultrasound coiling and endoscopic cyanoacrylate (glue) injection of the large fundal varices

BACKGROUND: Glue injection of large fundal varices (>2 cm) may be associated with embolic complications. Endoscopic ultrasound (EUS)-guided coiling with or without glue injection may be safe as coil may act as a scaffold to prevent embolization. OBJECTIVES: To find out the outcome of sequential treatment with EUS-guided coiling with or without endoscopic glue injection for large fundal varices. METHODS: After localization of varix with EUS, transgastric puncture was done with a 19-gauge needle, and 1–5 coils (12 mm) were placed in the varix. If immediate obliteration could not be achieved, EUS was repeated after 24 h. In case of persistent flow, endoscopy and direct glue injection were performed. RESULT: Ten patients (6 males, mean age 51 years) with large fundal varices and underwent EUS treatment. Nine were cirrhotics (child A:B:C - 2:6:1) and one had extrahepatic portal venous obstruction. All ten patients had recent bleed within 24 h of EUS, and one patient had active bleed during procedure. Mean varix size was 2.5 cm (± 0.4). Coiling was possible in all patients with mean number of coils of 3.6 (range 2–5). Immediate flow obliteration was seen in five patients; repeat EUS the next day showed persistent flow in four patients (40%) who underwent glue injection; mean volume used was 2 ml (range 1.5–3 ml). No symptoms related to embolization occurred, one patient had self-subsiding prolonged fever, and no rebleed occurred at 130 days (range 50–210). CONCLUSION: EUS-guided coiling with glue injection for large fundal varices is effective and safe.