{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:21:27Z","timestamp":1792419687582,"version":"4.5.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Curr Gastroenterol Rep"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose of Review<\/jats:title>\n                    <jats:p>Gastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation of obliteration with Doppler.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Findings<\/jats:title>\n                    <jats:p>In this paper, we review treatments for GV involving EUS, including EUS-guided injection of CYA and coils, either alone or in combination. We also discuss less common methods, including EUS-guided injection of thrombin and absorbable gelatin sponge. We then review literature comparing EUS-guided methods with direct endoscopic therapy and comparing individual EUS-guided methods with one another. We conclude by highlighting drawbacks of EUS in this field, including the unproven benefit over conventional therapy, lack of a standardized approach, and limited availability of expertise and necessary materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Novel EUS-based methods offer a unique opportunity to directly visualize and access gastric varices for treatment and obliteration. This may provide key advantages over current endoscopic or angiographic treatments. Comparative studies investigating the benefit of EUS over conventional therapy are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11894-020-00801-2","type":"journal-article","created":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T16:13:09Z","timestamp":1609603989000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices"],"prefix":"10.1007","volume":"23","author":[{"given":"Sushrut Sujan","family":"Thiruvengadam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Sedarat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,2]]},"reference":[{"key":"801_CR1","doi-asserted-by":"crossref","unstructured":"Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology [Internet]. John Wiley and Sons Inc.; 2017 [cited 2020 Jul 6];65:310\u201335. Available from: https:\/\/aasldpubs.onlinelibrary.wiley.com\/doi\/full\/10.1002\/hep.28906","DOI":"10.1002\/hep.28906"},{"key":"801_CR2","doi-asserted-by":"crossref","unstructured":"Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol [Internet]. Elsevier B.V.; 2018 [cited 2020 Jul 6];69:406\u201360. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29653741\/","DOI":"10.1016\/j.jhep.2018.08.009"},{"key":"801_CR3","doi-asserted-by":"crossref","unstructured":"Wani ZA, Bhat RA, Bhadoria AS, Maiwall R, Choudhury A. Gastric varices: classification, endoscopic and ultrasonographic management [Internet]. J. Res. Med. Sci. Isfahan University of Medical Sciences(IUMS); 2015 [cited 2020 Jul 6]. p. 1200\u20137. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26958057\/","DOI":"10.4103\/1735-1995.172990"},{"key":"801_CR4","doi-asserted-by":"crossref","unstructured":"Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology [Internet]. Hepatology; 1992 [cited 2020 Jul 6];16:1343\u20139. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/1446890\/","DOI":"10.1002\/hep.1840160607"},{"key":"801_CR5","doi-asserted-by":"crossref","unstructured":"Sabri SS, Saad WEA. Balloon-occluded retrograde transvenous obliteration (BRTO): technique and intraprocedural imaging. Semin Intervent Radiol [Internet]. Thieme Medical Publishers; 2011 [cited 2020 Jul 6];28:303\u201313. Available from: \/pmc\/articles\/PMC3312158\/?report=abstract.","DOI":"10.1055\/s-0031-1284457"},{"key":"801_CR6","doi-asserted-by":"crossref","unstructured":"Mamiya Y, Kanazawa H, Kimura Y, Narahara Y, Yamate Y, Nakatsuka K, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Hepatol Res [Internet]. Hepatol Res; 2004 [cited 2020 Jul 6];30:162\u20138. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/15588782\/","DOI":"10.1016\/j.hepres.2004.09.003"},{"key":"801_CR7","doi-asserted-by":"crossref","unstructured":"Suhocki P V., Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management [Internet]. Semin. Intervent. Radiol. Thieme Medical Publishers, Inc.; 2015 [cited 2020 Jul 6]. p. 123\u201332. Available from: \/pmc\/articles\/PMC4447874\/?report=abstract.","DOI":"10.1055\/s-0035-1549376"},{"key":"801_CR8","doi-asserted-by":"crossref","unstructured":"Al-Osaimi AMS, Sabri SS, Caldwell SH. Balloon-occluded retrograde transvenous obliteration (BRTO): preprocedural evaluation and imaging. Semin Intervent Radiol [Internet]. Thieme Medical Publishers; 2011 [cited 2020 Jul 6];28:288\u201395. Available from: \/pmc\/articles\/PMC3312157\/?report=abstract.","DOI":"10.1055\/s-0031-1284455"},{"key":"801_CR9","doi-asserted-by":"crossref","unstructured":"Soehendra N, Nam Ch. V, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy [Internet]. Endoscopy; 1986 [cited 2020 Jul 6];18:25\u20136. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/3512261\/","DOI":"10.1055\/s-2007-1013014"},{"key":"801_CR10","doi-asserted-by":"crossref","unstructured":"Bhat YM, Banerjee S, Barth BA, Chauhan SS, Gottlieb KT, Konda V, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc [Internet]. Mosby Inc.; 2013 [cited 2020 Jul 6];78:209\u201315. 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Procedure-related complications in gastric variceal obturation with tissue glue. World J Gastroenterol [Internet]. Baishideng Publishing Group Inc; 2017 [cited 2020 Jul 6];23:7746\u201355. Available from: \/pmc\/articles\/PMC5703934\/?report=abstract.","DOI":"10.3748\/wjg.v23.i43.7746"},{"key":"801_CR14","doi-asserted-by":"crossref","unstructured":"Mishra SR, Sharma BC, Kumar A, Sarin SK. Endoscopic cyanoacrylate injection versus \u03b2-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. Gut [Internet]. Gut; 2010 [cited 2020 Jul 6];59:729\u201335. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/20551457\/","DOI":"10.1136\/gut.2009.192039"},{"key":"801_CR15","doi-asserted-by":"crossref","unstructured":"R\u00edos Castellanos E, Seron P, Gisbert JP, Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension [Internet]. Cochrane Database Syst. 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There was no significant difference with regards to GV obliteration but a smaller amount of CYA was needed in the EUS-coil\/CYA group.","DOI":"10.1590\/s0004-2803.201900000-08"},{"key":"801_CR23","doi-asserted-by":"crossref","unstructured":"Michael PG, Antoniades G, Staicu A, Seedat S. Pulmonary glue embolism: an unusual complication following endoscopic sclerotherapy for gastric varices. Sultan Qaboos Univ Med J [Internet]. Sultan Qaboos University; 2018 [cited 2020 Jul 6];18:e231\u20135. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30210858\/","DOI":"10.18295\/squmj.2018.18.02.020"},{"key":"801_CR24","doi-asserted-by":"crossref","unstructured":"Lee YT, Chan FKL, Ng EKW, Leung VKS, Law KB, Yung MY, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc [Internet]. Mosby Inc.; 2000 [cited 2020 Jul 6];52:168\u201374. 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The EUS group also had less frequent GV rebleeding with a similar adverse event profile.","DOI":"10.1007\/s00464-018-6462-z"},{"key":"801_CR32","doi-asserted-by":"crossref","unstructured":"Franco MC. Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices. World J Gastrointest Endosc [Internet]. Baishideng Publishing Group Inc.; 2014 [cited 2020 Jul 6];6:254. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/24932378\/","DOI":"10.4253\/wjge.v6.i6.254"},{"key":"801_CR33","doi-asserted-by":"crossref","unstructured":"Bang JY, Al-Haddad MA, Chiorean M V., Chalasani NP, Kwo PY, Ghabril M, et al. Mo1485 comparison of direct endoscopic injection (DEI) and EUS-guided fine needle injection (EUS-FNI) of 2-octyl-cyanoacrylate for treatment of gastric varices. Gastrointest Endosc [Internet]. Elsevier BV; 2015 [cited 2020 Jul 6];81:AB437. 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Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31475222\/","DOI":"10.1055\/a-0915-9532"},{"key":"801_CR38","doi-asserted-by":"crossref","unstructured":"\u2022 Mukkada RJ, Antony R, Chooracken MJ, Francis J V., Chettupuzha AP, Mathew PG, et al. Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed. Indian J Gastroenterol [Internet]. Indian Society of Gastroenterology; 2018 [cited 2020 Jul 6];37:153\u20139. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29629510\/. This retrospective analysis compared patients who underwent direct endoscopic injection of CYA with patients who underwent EUS-guided coil injection. The EUS group had a significantly lower rate of rebleeding.","DOI":"10.1007\/s12664-018-0844-y"},{"key":"801_CR39","doi-asserted-by":"crossref","unstructured":"Khoury T, Massarwa M, Daher S, Benson AA, Hazou W, Israeli E, et al. Endoscopic ultrasound-guided angiotherapy for gastric varices: a single center experience. Hepatol Commun [Internet]. Wiley; 2018 [cited 2020 Jul 6];3. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30766958\/","DOI":"10.1002\/hep4.1289"},{"key":"801_CR40","doi-asserted-by":"crossref","unstructured":"Kozie\u0142 S, Pawlak K, B\u0142aszczyk \u0141, Jagielski M, Wiechowska-Koz\u0142owska A. Endoscopic ultrasound-guided treatment of gastric varices using coils and cyanoacrylate glue injections: results after 1 year of experience. J Clin Med [Internet]. MDPI AG; 2019 [cited 2020 Jul 6];8:1786. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31731504\/","DOI":"10.3390\/jcm8111786"},{"key":"801_CR41","doi-asserted-by":"crossref","unstructured":"\u2022\u2022 Bhat YM, Weilert F, Fredrick RT, Kane SD, Shah JN, Hamerski CM, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video). Gastrointest Endosc [Internet]. Mosby Inc.; 2016 [cited 2020 Jul 6];83:1164\u201372. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26452992\/. This large retrospective chart review examined the combined EUS-guided injection of coils and cyanoacrylate and found that this method was safe and effective for hemostasis in active bleeding and effective in primary and secondary prophylaxis. The authors also proposed a potential EUS-based algorithm for the management of GOV2\/IGV1.","DOI":"10.1016\/j.gie.2015.09.040"},{"key":"801_CR42","doi-asserted-by":"crossref","unstructured":"Ge PS, Bazarbashi AN, Thompson CC, Ryou M. Successful EUS-guided treatment of gastric varices with coil embolization and injection of absorbable gelatin sponge. VideoGIE [Internet]. Elsevier Inc; 2019 [cited 2020 Jul 6];4:154\u20136. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31032464\/","DOI":"10.1016\/j.vgie.2018.08.004"},{"key":"801_CR43","doi-asserted-by":"crossref","unstructured":"Bazarbashi AN, Wang TJ, Thompson CC, Ryou M. Endoscopic ultrasound-guided treatment of gastric varices with coil embolization and absorbable hemostatic gelatin sponge: a novel alternative to cyanoacrylate. Endosc Int Open [Internet]. Georg Thieme Verlag KG; 2020 [cited 2020 Jul 6];8:E221\u20137. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32010757\/","DOI":"10.1055\/a-1027-6708"},{"key":"801_CR44","doi-asserted-by":"crossref","unstructured":"Lo G-H, Lin C-W, Tai C-M, Perng D-S, Chen I-L, Yeh J-H, et al. A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage. Endoscopy [Internet]. Georg Thieme Verlag KG; 2020 [cited 2020 Jul 22];52:548\u201355. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32289853\/","DOI":"10.1055\/a-1127-3170"},{"key":"801_CR45","doi-asserted-by":"crossref","unstructured":"Frost J, Hebbar S. EUS-guided thrombin injection for management of gastric fundal varices. Endosc Int Open [Internet]. Georg Thieme Verlag KG; 2018 [cited 2020 Jul 6];6:E664\u20138. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29868631\/","DOI":"10.1055\/a-0599-0440"},{"key":"801_CR46","unstructured":"\u2022\u2022 Mohan BP, Chandan S, Khan SR, Kassab LL, Trakroo S, Ponnada S, et al. Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: Systematic review and meta-analysis [Internet]. Endoscopy. Georg Thieme Verlag; 2020 [cited 2020 Jul 6]. p. 259\u201367. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32028533\/. This meta-analysis compared direct endoscopic injection of CYA with EUS-guided treatment of GV. The rate of GV obliteration was significantly higher in the EUS group and the EUS group had a significantly lower rate of late reblessing and GV recurrence in differences which trended towards significance. Among different EUS-guided methods, combined coil and CYA injection was associated with less GV recurrence than CYA injection alone."},{"key":"801_CR47","doi-asserted-by":"crossref","unstructured":"\u2022\u2022 McCarty TR, Bazarbashi AN, Hathorn KE, Thompson CC, Ryou M. Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis [Internet]. Endosc. Ultrasound. Spring Media; 2020 [cited 2020 Jul 6]. p. 6\u201315. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31417066\/. This meta-analysis compared different EUS-guided methods for GV treatment. The authors found that combined coil and CYA injection had a significant higher rate of GV obliteration and had a lower need for reintervention than CYA or coil injection alone. EUS-coil\/CYA also had a lower rebleeding rate and fewer adverse events than CYA injection alone. These findings indicate that combining coil and CYA injection may have benefit, possibly because coils act as a scaffold to retain glue.","DOI":"10.4103\/eus.eus_37_19"},{"key":"801_CR48","doi-asserted-by":"crossref","unstructured":"Mattamal GJ. US FDA perspective on the regulations of medical-grade polymers: cyanoacrylate polymer medical device tissue adhesives. Expert Rev Med Devices [Internet]. Expert Rev Med Devices; 2008 [cited 2020 Jul 6];5:41\u20139. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/18095895\/","DOI":"10.1586\/17434440.5.1.41"}],"container-title":["Current Gastroenterology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11894-020-00801-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11894-020-00801-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11894-020-00801-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:16:31Z","timestamp":1778494591000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11894-020-00801-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["801"],"URL":"https:\/\/doi.org\/10.1007\/s11894-020-00801-2","relation":{},"ISSN":["1522-8037","1534-312X"],"issn-type":[{"value":"1522-8037","type":"print"},{"value":"1534-312X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"assertion":[{"value":"23 November 2020","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2021","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"This article does not contain any studies with human or animal subjects performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights and Informed Consent"}}],"article-number":"1"}}