Endoscopic Ultrasound Guided Treatment of Peristomal Varices

Abstract

Background and aims The use of endoscopic ultrasound (EUS) for peristomal varices (PV) is limited to case reports. Methods Patients who underwent EUS-guided treatment of PV with cyanoacrylate (CYA) and/or coils between 04/2013 and 12/2019 were identified. All had failed previous therapies or had comorbidities precluding other options. Endoscopic technique, adverse events (AEs), rebleeding and repeat interventions were assessed. Results 20 patients (12 male, median: 62 years (IQR, 54.8-69.5) underwent initial EUS PV injection of CYA for secondary (n=19) or primary prophylaxis (n=1). Within 30 days, AEs occurred in 11 (55%) and 8 were mild. During a median 2.5 months (IQR, 2-8.5) follow-up, confirmed (n=6) or suspected (n=2) PV bleeding recurred; five of 8 recurrences were retreated with CYA and/or coils without AEs. After retreatment, PV bleeding recurred in two a median 6 months (IQR, 6-30) later. Conclusion EUS appears to be a safe and promising technique for treatment of PV.