Clinical Endoscopy

Focused Review Series: Endoscopic Hemostasis: An Overview of Principles and Recent Applications

Endoscopic Therapy and Radiologic Intervention of Acute Gastroesophageal Variceal Bleeding: Jeong Eun Song, Byung Seok Kim; Clin Endosc 2019;52(5):407-415. Published online September 30, 2019; DOI: https://doi.org/10.5946/ce.2019.178

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.

Citations

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Liver cirrhosis: current status and treatment options using western or traditional Chinese medicine
Shihao Zheng, Chengyuan Xue, Size Li, Xiaobin Zao, Xiaoke Li, Qiyao Liu, Xu Cao, Wei Wang, Wenying Qi, Hongbo Du, Peng Zhang, Yongan Ye
Frontiers in Pharmacology.2024;[Epub] CrossRef
Efficacy of early re-ligation after endoscopic gastric glue injection combined with endoscopic variceal ligation in preventing rebleeding of esophagogastric varices in patients with cirrhosis
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Archives of Pharmacy Practice.2022; 13(4): 7. CrossRef
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EMERGENCY MEDICINE.2022; 18(8): 14. CrossRef

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Focused Review Series: EUS-Guided Therapeutic Interventions

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future: Philip S.J. Hall, Christopher Teshima, Gary R. May, Jeffrey D. Mosko; Clin Endosc 2017;50(2):138-142. Published online March 30, 2017; DOI: https://doi.org/10.5946/ce.2017.048

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

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Sheng Wang, Siyu Sun, Xiang Liu, Nan Ge, Guoxin Wang, Jintao Guo, Wen Liu, Jinlong Hu
Scandinavian Journal of Gastroenterology.2020; 55(3): 330. CrossRef
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Claudio Giovanni De Angelis, Pablo Cortegoso Valdivia, Stefano Rizza, Ludovica Venezia, Felice Rizzi, Marcantonio Gesualdo, Giorgio Maria Saracco, Rinaldo Pellicano
Journal of Clinical Medicine.2020; 9(3): 866. CrossRef
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Seminars in Liver Disease.2018; 38(02): 145. CrossRef
Endoscopic Therapy for Variceal Bleeding: from Patient Preparation to Available Techniques and Rescue Therapies
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Current Hepatology Reports.2017; 16(4): 398. CrossRef
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Special Issue Articles of IDEN 2012

Usefulness of Endoscopic Ultrasound in Esophagogastric Varices: Jae-Jun Shim; Clin Endosc 2012;45(3):324-327. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.324

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS) is a useful diagnostic tool for evaluation of esophagogastric varices and guidance of endoscopic therapy. EUS can visualize not only collateral veins around the esophagus but also perforating veins that connect esophageal varices with collateral veins. They are associated with high risk of bleeding and early recurrence after initial variceal eradication. Isolated gastric varices can be easily diagnosed using EUS that mimic thickened gastric folds or subepithelial tumors. EUS-guided endoscopic therapy is a challenging field of variceal bleeding. It has a potential role for assistance of interventions and evaluation of treatment outcome.

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Study Advances in Diagnosis and Treatment of Esophageal Collateral Varices in Cirrhosis
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Comparison of Endoscopic Ultrasound-guided Cyanoacrylate Injection and Transjugular Intrahepatic Portosystemic Shunt in the Prevention of Gastric Varices Rebleeding
Zhuang Zeng, Zhihong Wang, Jing Jin, Fumin Zhang, Qianqian Zhang, Xuecan Mei, Derun Kong
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 518. CrossRef
Role of Endoscopic Ultrasound in Liver Disease: Where Do We Stand?
Tajana Pavic, Ivana Mikolasevic, Dominik Kralj, Nina Blazevic, Anita Skrtic, Ivan Budimir, Ivan Lerotic, Davor Hrabar
Diagnostics.2021; 11(11): 2021. CrossRef
Role of endoscopic ultrasound in liver disease: Where do we stand in 2017?
Hamzeh A Saraireh, Mohammad Bilal, Shailendra Singh
World Journal of Hepatology.2017; 9(24): 1013. CrossRef
Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices
Yang Yu, Sheng-Lin Qi, Yong Zhang
World Journal of Gastroenterology.2017; 23(44): 7875. CrossRef

6,821 View
71 Download
5 Crossref

Case Report

Successful Treatment of Early Gastric Cancer Adjacent to a Fundal Varix by Endoscopic Submucosal Dissection and Endoscopic Cyanoacrylate Therapy: Yeon Soo Kim, Won Young Cho, Joo Young Cho, So Young Jin; Clin Endosc 2012;45(2):169-173. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.169

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic liver cirrhosis presented with early gastric cancer in the cardia and type 1 isolated gastric varices in the fundus. The two lesions were so close together that treatment was not easy. The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

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Clinical Endoscopy.2013; 46(3): 224. CrossRef

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