Interventional Endoscopic Ultrasound (EUS) (on demand)-EUS Coiling of Gastric Varices

Video Transcription

Video Summary

Marvin Yu presented an EUS-guided coiling case involving a 51-year-old woman with alcohol-related cirrhosis and severe bleeding from presumed gastric varices. A large clot prevented conventional endoscopic treatment, so the team performed EUS-guided coil therapy during emergency management.<br /><br />For large varices, Yu generally uses a 19-gauge needle and 0.035-inch coils, selecting a coil diameter about 20–40% larger than the varix to reduce migration risk. He favors fluoroscopy alongside real-time Doppler, and typically adds absorbable gelatin sponge rather than glue. Before puncturing, the team tests the planned coil-and-needle setup and prepares the room, since the endoscopist may be unable to move once positioned. Water in the stomach can help distinguish intramural varices from surrounding vessels.<br /><br />The panel discussed glue as an option for urgent hemostasis, while coil-based EUS treatment may be reserved for experienced operators or later secondary prophylaxis. When feasible, Yu approaches through the esophagus and targets the variceal complex, anchoring the first coil before packing additional sections. Follow-up is typically at one month, then at longer intervals if treatment appears successful. EUS therapy may also be considered for selected prophylactic cases, though primary prophylaxis remains controversial.

Asset Subtitle

Marvin Ryou, MD

Meta Tag

Concept Gastric Varices

Concept Variceal Bleeding

Concept Endoscopic Ultrasound

Concept Coil Deployment

Concept Hemostasis

Keywords

EUS-guided coiling

gastric varices

cirrhosis

endoscopic hemostasis

embolization coil

fluoroscopy

gelatin sponge

19-gauge needle

glue therapy