Endoscopic ultrasound-guided therapies in the treatment of gastric varices: An in-depth examination of associated adverse events

The Baveno VII consensus, released in 2023, recommends that the endoscopic treatment of choice for managing bleeding gastric varices (GV) is endoscopic ultrasound (EUS)-guided treatment, specifically EUS-guided cyanoacrylate (CYA) glue injection. This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates, compared to other endoscopic techniques. Despite its efficacy, CYA injection for GV has been linked to rare but serious adverse events, such as glue embolization leading to pulmonary embolism, infection/bacteremia, splenic infarction, intra-procedural and post-procedural complications. The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance, aiming to more accurately direct the injection into the varix, reduce the volume of injected glue, target the perforating vein when possible, and confirm obliteration of GV via Doppler examination.