Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies

Abstract

Endoscopic ultrasound (EUS) guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists. Gastric variceal bleeding comprises 20% of all variceal bleeding and is associated with high morbidity and mortality. Historically, endoscopic injection of thrombosis-inducing agents such as glue has been used. However, glue injection carries potential risks including systemic embolization, damage to the endoscope, and recurrent bleeding. The introduction of hemostatic coils has revolutionized the endoscopic approach, with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices (GVs). When compared with conventional glue injection, EUS-guided embolization is associated with improved visualization, higher efficacy, and better safety profile. Despite its expanding adoption, the standardization of EUS guided embolization remains a challenge. High-quality studies are needed to standardize this promising technique and define its role in clinical practice. In this review, we will discuss the indications, efficacy, techniques, and various approaches for EUS-guided embolization of GVs.