Value of endoscopic ultrasound-guided coil implantation combined with glue injection for the secondary prevention of tumorous gastric fundal variceal bleeding
Objective To evaluate the clinical efficacy and safety of endoscopic ultrasound(EUS)-guided coil implantation combined with glue injection for preventing rebleeding of tumorous gastric fundal varices.Methods A retrospective analysis was performed on the clinical data of patients who underwent EUS-guided coil implantation combined with glue injection due to tumorous gastric fundal variceal bleeding from September 2017 to December 2020 in the First Affiliated Hospital,Zhejiang University School of Medicine.The basic characteristics and endoscopic manifestations of patients treated with this technique were analyzed,and the success rate of this technique,the usage of tissue glue and coil,the variceal obliteration rate and the incidence of complications such as pulmonary embolism were analyzed.Patients were followed up over a long period of time to obtain data on rebleeding.At the same time,patients were divided into complete obliteration group and incomplete obliteration group according to the endoscopic performance after the treatment,and the rebleeding rate in the two groups was compared.Results Among the 41 patients included in this study,18 cases(43.90％)had single isolated gastric varices type 1,and 23 cases(56.10％)had gastroesophageal varices combined.Fourteen cases had signs of recent bleeding such as thrombi and ulcers under endoscopy,and 13 cases had combined portal hypertensive gastropathy.All patients successfully completed the operation of EUS-guided coil implantation combined with glue injection.The technical success rate for the first attempt was 92.68％(38/41).The one-time pre-installation success rate of coils was 95.12％(39/41).The success rate of target vessel aspiration under EUS guidance was 100.00％(41/41).The release success rate of coil was 97.56％(40/41).The number of coils used was 1.12±0.33,and the amount of tissue glue used after inserting the coils was 1.54±0.46 mL.The target vessel obliteration rate after operation was 97.56％(40/41),and the complete gastric fundal variceal obliteration rate was 51.22％(21/41).There were 2 cases(4.88％)of intraoperative bleeding,1 case stopped spontaneously,and 1 case successfully stopped bleeding after additional injection of tissue glue under direct endoscopic vision.No patient had symptoms of pulmonary embolism such as decreased oxygen saturation during the operation.Postoperative computed tomography angiography of pulmonary artery or lung computed tomography was performed in 24 cases,of which 1 case(4.17％)showed distal pulmonary artery embolism,but there were no relevant clinical manifestations.The patients were followed up for 21.64±16.86 months(1-50 months)after the surgery.There were 13 cases(31.71％)of recurrent gastrointestinal bleeding after the surgery,no rebleeding within 5 days,2 cases of rebleeding within 3 months,5 cases from 3 to 12 months,and 6 cases more than 1 year.Among the 13 cases of recurrent bleeding after the surgery,the recurrence rate of bleeding after operation in the complete obliteration group was 23.81％(5/21),which was lower than that in the incomplete obliteration group with 40.00％(8/20),but there was no statistically significant difference(x2=1.240,P=0.265).Conclusion EUS-guided coil implantation combined with glue injection has good secondary prevention value and safety for tumorous gastric fundal variceal bleeding,and is worthy of clinical promotion and application.
Esophageal and gastric varicesEndoscopic ultrasonographyCyanoacrylatesTumorous gastric fundal varicesTissue glueGastro-renal shunt
万方数据
维普
