P- 75 comparison of eus-guided coil plus cyanoacrylate vs conventional cyanoacrylate technique in the management of acute gastric variceal bleeding. which one is better?

Introduction and Objectives: Gastric varices affect approximately 20% of patients with portal hypertension; bleeding appears in 50-80%, with a mortality of 45%. There are two therapeutic options, cyanoacrylate and TIPS. The latter, due to its complexity, is limited. Cyanoacrylate is a more accessible technique, which can be performed conventionally by upper endoscopy (EGD) with direct visualization of the varices or guided by endoscopic ultrasound (EUS). This study aimed to compare the EUS-guided coil plus cyanoacrylate vs. the conventional technique of injection of cyanoacrylate in the management of acute gastric variceal bleeding. Materials and Methods: Twenty-three cases of acute gastric variceal bleeding that received cyanoacrylate either by EUS-guided or conventional technique due to active or recent bleeding were analyzed, assessing their ability to stop it and the presence of bleeding at the same admission. Results: Two groups were similar; 10 patients were male and 13 female. The type of gastric varices found was GOV1 in 12 patients (52.1%), GOV2 in 8 patients (34.7%) and in 3 patients (13.2%) both types were documented. At the time of EGD, 21.7% had active bleeding and bleeding was successfully controlled in all patients. There was one case of re-bleeding in the group of conventional cyanoacrylate technique that was controlled with EUS-guided embolization. The average number of injections was lower with EUS-guided therapy. Conclusions: Cyanoacrylate is essential in the approach to acute bleeding from gastric varices. The EUS method seems to be safer. However, it requires training in the EUS, in addition to being more expensive. In bleeding without being able to visualize gastric varices veins by direct visualization, the EUS is the best option. Any endoscopy unit that handles digestive bleeding requires personnel and equipment trained to have both techniques.