Endoscopic ultrasound-guided coil-assisted retrograde transgastric occlusion of shunt efferent for gastric variceal bleeding.

BACKGROUND AND AIMS: EUS-guided therapy for fundal varices targets the gastric shunt or afferent feeders. In cases with multiple feeders, this may not achieve complete obliteration. We aimed to target the single efferent channel in a patient with multiple feeder vessels.

METHODS

We describe EUS-guided occlusion of the shunt efferent in a patient with gastric variceal bleed and multiple inflow tracts. The efferent was traced from the left renal vein and targeted with coils and cyanoacrylate glue.

RESULTS

Coil plus glue embolization of the shunt efferent achieved complete variceal obliteration. The patient had no further variceal bleeding or decompensation at 6 months. At 1-year follow-up, the patient was asymptomatic; small esophageal varices were noted.

CONCLUSIONS

EUS-guided coil-assisted retrograde transgastric occlusion is a safe and effective alternative to interventional radiology-guided therapy of gastric varices in cases with multiple afferents or feeder vessels. Development of new esophageal varices is a recognized limitation and should be monitored.