TorontoGiFellow

Source: Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: A randomized controlled trial - Sarin et al In a trial of 89 patients with >20 mm size of GOV2 (after eradication of EV) or IGV1, patients treated with CyA had significantly low risk of bleeding at median follow-up of 26 months (13%), compared to patients randomized to NSBB (28%) or controls (45%)  Main criticism: Majority of patients were GOV2. Only 13 patients out of 89 had IGV1, therefore, difficult to draw conclusions at management of IGV1.

 EUS: Keep 0.5 ml Glubran + 0.5 ml sterile water ready in Syringe A. Keep 10 ml of sterile water ready in Syringe B. Step 1 - Confirm the varices are 'intraluminal' Decide target of intervention (feeder / main varix) Step 2: Stab the varix with 19G FNB needle. Attach a 10 ml syringe with sterile water to FNB needle Step 3: To confirm location inside varix, flush some water. Then aspirate to confirm blood. Then flush back to 'wash blood' from the needle lumen Step 4: Attach white hub of the Nester  loading cannula to needle tip. Using Needle stylet, advance the coil from the Nester catheter to, inside the needle lumen. Then detach the Nester catheter from FNB needle. Insert the stylet again, to continue to push the coil across the needle lumen in to varix Step 5: By continuing to advance the needle stylet, push the coil in to the varix under EUS guidance. Once completely deployed, remove the needle stylet.  Step 5a - further coil can be deployed based on size of varix, b...