A case of cirrhosis with gastric varices and hypersplenism treated by endoscopic ultrasound-guided devascularization and partial splenic embolization (with video)
Year: 2025
Type: article
Study design: Case Report
Abstract: Variceal bleeding and hypersplenism are major complications of cirrhosis. While endoscopic N -butyl-2-cyanoacrylate injection and partial splenic embolization (PSE) are recommended [ 1 ], they entail risks of pulmonary embolism and splenic abscess. Recently, endoscopic ultrasound (EUS)-guided vascular intervention has emerged as an alternative [ 2 ]. In this case, we combined EUS-guided selective variceal devascularization (EUS-SVD) and EUS-guided PSE (EUS-PSE) to manage cirrhosis-induced gastric varices and hypersplenism. A 61-year-old man with alcoholic cirrhosis was referred to our hospital for recurrent melena. Despite previous transfusion, he was experiencing severe anemia due to hypersplenism. Endoscopy revealed esophagogastric varices and a venous aneurysm on the posterior gastric wall ([ Fig. 1 ] a, b ). Based on multidisciplinary assessment, we opted for EUS-SVD and EUS-PSE ([ Video 1 ]). During the EUS-SVD procedure, the left gastric vein was identified and occluded using sequential sclerotherapy with lauromacrogol/tissue adhesive and an 8 × 12mm coil deployment ([ Fig. 1 ] c ). Successful thrombosis was confirmed, evidenced by a hyperechoic shadow and the absence of blood flow ([ Fig. 1 ] d ). After 1 month without rebleeding or adverse events, EUS-guided PSE was performed. Under EUS guidance, a primary splenic artery branch was identified and punctured with a 22G needle. An 8 mm × 12 mm coil was deployed, followed by lauromacrogol for tracing and 1 mL tissue adhesive for embolization ([ Fig. 2 ] a ). Subsequent imaging identified a lack of flow signal in the splenic artery and hyperechoic nodular in splenic parenchyma, indicating ischemia ([ Fig. 2 ] b ). Postoperatively, the patient experienced a transient fever of 38.6°C, managed with imipenem for 7 days. CT on day 4 confirmed over 50% splenic infarction and proper coil placement ([ Fig. 2 ] c, d ). The patient’s stool color normalized by discharge, without rebleeding or adverse events during 1-month follow-up. Download Video Endoscopic ultrasound-guided devascularization for gastric varices and endoscopic ultrasound-guided partial splenic embolization for hypersplenism.Video 1 Fig. 1 EUS-SVD in patient with gastric varices. a, b Endoscopy identified varices at the end of the esophagus (red color sign−) and venous aneurysm at the fundus of the stomach (red color sign+). c During lauromacrogol injection, intravascular hyperechoic shadows (red arrow) confirmed the needle in the left gastric vein. d After embolization, the blood flow signal in the venous cluster disappeared, replaced by the hyperechoic shadow. EUS-SVD, EUS-guided selective variceal devascularization. Fig. 2 EUS-PSE for the treatment of hypersplenism. a Under EUS guidance, an 8 mm × 12 mm coil was placed in the splenic artery (red arrow). b EUS identified the disappearance of the blood flow signal in the primary splenic artery branch after embolization. c CT revealed over 50% spleen infarction (green arrow) and the embolization coils (red arrow). d Three-dimensional CT reconstruction showed embolization coils in the left gastric vein and primary splenic artery branch (red arrow). CT, computed tomography; EUS, endoscopic ultrasound; EUS-PSE, EUS-guided partial splenic embolization. EUS-SVD demonstrates 95% clinical success with under 15% adverse events. No adverse events have been reported with EUS-PSE [ 3 ]. Herein, the combined therapy achieved success for cirrhosis-induced gastric varices and hypersplenism. Postoperative fever was attributed to sterile inflammation and absorption, which resolved in 3 days without CT evidence of splenic abscess. Endoscopy_UCTN_Code_TTT_1AS_2AG Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 19 December 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2749-8056
Authors: Tianze Shi, Jialiang Huang, Guilian Cheng, Duanmin Hu
Institution: Second Affiliated Hospital of Soochow University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4417535698