Through-the-scope Doppler US-guided cyanoacrylate injection: a new technique for the treatment of gastric variceal hemorrhage

摘要

Gastric variceal hemorrhage (GVH) is a serious complication of portal hypertension. Cyanoacrylate injection is the recommended first-line treatment for GVH. Assessment of adequate hemostasis of gastric varices after glue injection can be challenging. The current practice of probing for consistency is subjective. It has been shown that the risk of glue-related adverse events increases when larger volumes of glue are injected. We describe using an audible through-the-scope, non-EUS, non-imaging Doppler US probe to objectively gauge the response and volume of glue needed to achieve hemostasis. A 64-year-old man with cirrhosis presented with GVH. A continuous low-pitched hum was heard when the Doppler US probe was used to examine the gastric varix, indicating active venous" blood flow. Cyanoacrylate was injected into the gastric varix. The gastric varix was re-examined after 2 minutes with Doppler US and, while still soft, the Doppler signalwas absent, indicating adequate hemostasis (Fig. 1.). Glue injection was completed when no targeted areas demonstrated an audible Doppler signal. The patient had no recurrent bleeding at 6 months. In summary, use of the through-the-scope Doppler US probe provides a straightforward and objective measure of variceal blood flow. Doppler US is useful in determining adequate hemostasis immediately after glue injection during acute GVH and subsequent surveillance endoscopies (Video 1, available online at www.giejournal.org).