Technical and clinical outcomes following EUS-guided thrombin injection and coil implantation for parastomal varices
Todd, Andrew Shekhar, Chander O'Rourke, Joanne Forde, Colm Pallan, Arvind Wadhwani, Sharan Suresh Tripathi, Dhiraj Mahon, Brinder Singh
Todd, Andrew
Shekhar, Chander
O'Rourke, Joanne
Forde, Colm
Pallan, Arvind
Wadhwani, Sharan Suresh
Tripathi, Dhiraj
Mahon, Brinder Singh
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Affiliation
University Hospitals Birmingham NHS Foundation Trust; Walsall Healthcare NHS Trust; University of Birmingham
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Publication date
2023-08
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Abstract
Background and aims: Bleeding from parastomal varices causes significant morbidity and mortality. Treatment options are limited, particularly in high-risk patients with significant underlying liver disease and other comorbidities. The use of EUS-guided embolisation coils combined with thrombin injection in gastric varices has been shown to be safe and effective. Our institution has applied the same technique to the treatment of parastomal varices.
Methods: A retrospective review was performed of 37 procedures on 24 patients to assess efficacy and safety of EUS-guided injection of thrombin, with or without embolisation coils for treatment of bleeding parastomal varices. All patients had been discussed in a multidisciplinary team meeting, and correction of portal hypertension was deemed to be contraindicated. Rebleeding was defined as stomal bleeding that required hospital admission or transfusion.
Results: All patients had significant parastomal bleeding at the time of referral. 100% technical success rate was achieved. 70.8% of patients had no further significant bleeding in the follow-up period (median 26.2 months) following one procedure. 1-year rebleed-free survival was 80.8% following first procedure. 7 patients (29.1%) had repeat procedures. There was no significant difference in rebleed-free survival following repeat procedures. Higher age was associated with higher risk of rebleeding. No major procedure-related complications were identified.
Conclusions: EUS-guided thrombin injection, with or without embolisation coils, is a safe and effective technique for the treatment of bleeding parastomal varices, particularly for patients for whom correction of portal venous hypertension is contraindicated.
Keywords: ENDOSCOPIC PROCEDURES; ENDOSCOPIC ULTRASONOGRAPHY; GASTROINTESTINAL BLEEDING; PORTAL HYPERTENSION.
Citation
Todd A, Shekhar C, O'Rourke J, Forde C, Pallan A, Wadhwani SS, Tripathi D, Mahon BS. Technical and clinical outcomes following EUS-guided thrombin injection and coil implantation for parastomal varices. BMJ Open Gastroenterol. 2023 Aug;10(1):e000819. doi: 10.1136/bmjgast-2021-000819. PMID: 37562855; PMCID: PMC10423785.
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Article