EUS-Guided Treatment of Gastrointestinal Bleeding

  • Larissa L. Fujii-Lau
  • Louis M. Wong Kee Song
  • Michael J. LevyEmail author


Gastrointestinal (GI) bleeding is one of the most challenging problems that gastroenterologists manage. Conventional therapies for endoscopic hemostasis include epinephrine injection, band ligation, hemoclip placement, and/or thermal therapy. However, there is a subset of patients in whom standard endoscopic hemostatic treatment fails or is unsuitable. Historically, these patients underwent surgical or interventional radiologic therapy to manage the difficult or refractory bleed. Endoscopic ultrasound (EUS)-guided angiotherapy is an emerging and promising treatment modality for select difficult-to-treat bleeding lesions. This chapter highlights novel EUS techniques used to treat patients with challenging GI hemorrhage.


Endosonography Vascular Varices Pseudoaneurysm Coil Glue Cyanoacrylate Hemostasis Angiotherapy Gastrointestinal bleeding 




Supplementary material

Video 6.1

Glue and lipiodol were injected under EUS guidance, resulting in complete filling of the variceal network. The glue migrated into the feeding vessel with protection provided by the occlusion balloon to prohibit shunt embolization (MP4 99875 kb)


  1. 1.
    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. 1992;16(6):1343–9.CrossRefGoogle Scholar
  2. 2.
    Romero-Castro R, Pellicer-Bautista F, Giovannini M, Marcos-Sanchez F, Caparros-Escudero C, Jimenez-Saenz M, et al. Endoscopic ultrasound (EUS)-guided coil embolization therapy in gastric varices. Endoscopy. 2010;42(Suppl 2):E35–6.CrossRefGoogle Scholar
  3. 3.
    Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, Subtil-Inigo JC, Junquera-Florez F, Gornals JB, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013;78(5):711–21.CrossRefGoogle Scholar
  4. 4.
    Fujii-Lau LL, Law R, Wong Kee Song LM, Gostout CJ, Kamath PS, Levy MJ. Endoscopic ultrasound (EUS)-guided coil injection therapy of esophagogastric and ectopic varices. Surg Endosc. 2016;30:1396.CrossRefGoogle Scholar
  5. 5.
    Lee YT, Chan FK, Ng EK, Leung VK, Law KB, Yung MY, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52(2):168–74.CrossRefGoogle Scholar
  6. 6.
    Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, Marcos-Sanchez F, Caunedo-Alvarez A, Ortiz-Moyano C, et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66(2):402–7.CrossRefGoogle Scholar
  7. 7.
    Weilert F, Binmoeller KF. EUS-guided vascular access and therapy. Gastrointest Endosc Clin N Am. 2012;22(2):303–14, x.CrossRefGoogle Scholar
  8. 8.
    Binmoeller KF, Weilert F, Shah JN, Kim J. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos). Gastrointest Endosc. 2011;74(5):1019–25.CrossRefGoogle Scholar
  9. 9.
    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. 2016;83(6):1164–72.CrossRefGoogle Scholar
  10. 10.
    Sato T, Yamazaki K, Akaike J. Evaluation of the hemodynamics of rectal varices by endoscopic ultrasonography. J Gastroenterol. 2006;41(6):588–92.CrossRefGoogle Scholar
  11. 11.
    Sharma M, Rai P, Bansal R. EUS-assisted evaluation of rectal varices before banding. Gastroenterol Res Pract. 2013;2013:619187.CrossRefGoogle Scholar
  12. 12.
    Weilert F, Shah JN, Marson FP, Binmoeller KF. EUS-guided coil and glue for bleeding rectal varix. Gastrointest Endosc. 2012;76(4):915–6.CrossRefGoogle Scholar
  13. 13.
    Philips CA, Augustine P. Endoscopic ultrasound-guided management of bleeding rectal varices. ACG Case Rep J. 2017;4:e101.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Connor EK, Duran-Castro OL, Attam R. Therapy for recurrent bleeding from rectal varices by EUS-guided sclerosis. Gastrointest Endosc. 2015;81(5):1280–1.CrossRefGoogle Scholar
  15. 15.
    Fockens P, Meenan J, van Dullemen HM, Bolwerk CJ, Tytgat GN. Dieulafoy’s disease: endosonographic detection and endosonography-guided treatment. Gastrointest Endosc. 1996;44(4):437–42.CrossRefGoogle Scholar
  16. 16.
    Ribeiro A, Vazquez-Sequeiros E, Wiersema MJ. Doppler EUS-guided treatment of gastric Dieulafoy’s lesion. Gastrointest Endosc. 2001;53(7):807–9.CrossRefGoogle Scholar
  17. 17.
    Roach H, Roberts SA, Salter R, Williams IM, Wood AM. Endoscopic ultrasound-guided thrombin injection for the treatment of pancreatic pseudoaneurysm. Endoscopy. 2005;37(9):876–8.CrossRefGoogle Scholar
  18. 18.
    Robinson M, Richards D, Carr N. Treatment of a splenic artery pseudoaneurysm by endoscopic ultrasound-guided thrombin injection. Cardiovasc Intervent Radiol. 2007;30(3):515–7.CrossRefGoogle Scholar
  19. 19.
    Lameris R, du Plessis J, Nieuwoudt M, Scheepers A, van der Merwe SW. A visceral pseudoaneurysm: management by EUS-guided thrombin injection. Gastrointest Endosc. 2011;73(2):392–5.CrossRefGoogle Scholar
  20. 20.
    Chaves DM, Costa FF, Matuguma S, Lera Dos Santos ME, de Moura EG, Maluf Filho F, et al. Splenic artery pseudoaneurysm treated with thrombin injection guided by endoscopic ultrasound. Endoscopy. 2012;44(Suppl 2 UCTN):E99–100.CrossRefGoogle Scholar
  21. 21.
    Bhat YM, Banerjee S, Barth BA, Chauhan SS, Gottlieb KT, Konda V, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc. 2013;78(2):209–15.CrossRefGoogle Scholar
  22. 22.
    Law R, Fujii-Lau L, Wong Kee Song LM, Gostout CJ, Kamath PS, Abu Dayyeh BK, et al. Efficacy of endoscopic ultrasound-guided hemostatic interventions for resistant nonvariceal bleeding. Clin Gastroenterol Hepatol. 2015;13(4):808–12.e1.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Larissa L. Fujii-Lau
    • 1
    • 2
  • Louis M. Wong Kee Song
    • 3
  • Michael J. Levy
    • 3
    Email author
  1. 1.Division of GastroenterologyQueens Medical CenterHonoluluUSA
  2. 2.University of HawaiiHonoluluUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

Personalised recommendations