Insights into the role of endoscopic ultrasound–guided vascular therapy

Therapeutic Advances in Gastrointestinal Endoscopy

Review

Carlos Robles-Medranda¹  Roberto Oleas² 

[1] Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Av. Abel Romeo Castillo y Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Ecuador ;Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador;

关键词: endoscopic ultrasonography;    endosonography;    gastric variceal bleeding;    gastro-intestinal hemorrhage;    portal vein;   

DOI  :  10.1177/2631774519878282

 received in 2019-04-24, accepted in 2019-09-04,  发布年份 2019

来源: Sage Journals

【 摘 要 】

Gastroesophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis and portal hypertension. The endoscopic injection of cyanoacrylate is considered as the first-line alternative for gastric varices treatment; however, the incidence of adverse events supports the endoscopic ultrasound–guided approach. Endoscopic ultrasound–guided interventions are a safe and feasible technique for the injection of sclerosants, cyanoacrylate, thrombin, and the deployment of coils into targeted vessels. This review article aims to offer an overview of the role of endoscopic ultrasound–guided vascular therapy and present the available data regarding endoscopic ultrasound–guided management of gastrointestinal bleeding and other vascular therapies. The available data have shown the superiority of endoscopic ultrasound–guided endovascular therapy over the endoscopic technique, which supports the implementation of endoscopic ultrasound–guided therapy in therapeutical algorithms and guidelines. Regarding whether injecting cyanoacrylate, the deployment of coils, or combined therapy, we recommend the endoscopic ultrasound–guided combined therapy in patients with gastric varices due to the high eradication rate with lower rebleeding and reintervention rates. Multicenter worldwide studies are required to confirm the actual clinical applicability of endoscopic ultrasound–guided endovascular therapy and establish treatment algorithms. Endoscopic ultrasound offered a safe and effective alternative in the management of variceal and nonvariceal gastrointestinal bleeding, with the implementation of new diagnostic and treatment options for various gastrointestinal conditions, representing a new territory for research and development.

【 授权许可】

CC BY-NC   
© The Author(s), 2019

【 图 表 】

Figure 6.