Patients above 18 years old with gastric varices (GV) on the initial standard diagnostic upper endoscopy will be enrolled and treated using angiography in EUS-injection of coils + CYA. GV will be classified according to Sarin and Kumar classification. Only gastro-esophageal varices type II (GOV II) (fundal varices communicating with esophageal varices) and isolated gastric varices type I (IGV I) (fundal varices within a few centimeters of the gastric cardia) will be included. Gastro-esophageal varices type I (GOV I) will be excluded. Patients with active bleeding and history of previous bleeding due to GV (secondary prophylaxis) will be included as well as patients with high-risk GV suitable for primary prophylaxis according to Baveno VI consensus. T

Gastric Varices

Doppler imaging will be used to allow direct visualization of the varices flow. The gastric vessels will be followed from the cardia to the proximal part of the esophagus, to detect the feeding vessel (FV). Once the FV has been found, a 19-gauge EUS-FNA will be used to access the vessel. An angiography will be performed using 5-10 ml of water-soluble contrast under fluoroscopy, to ensure intravascular location and study varix flow direction. Finally, patients will be treated by EUS-deployment of coils followed by CYA injection. The coils will be delivered into the vessel through the FNA needle, using the stylet as a pusher. The 2-Octyl-CYA will be used. It will be injected always after the coils deployment and then 1 mL of saline solution will be used to flush the glue completely.

angiography in EUS-injection of coils + CYA

Ecuadorian Institute of Digestive Diseases, Omnihospital

Angiography for Evaluation of the Feeder Vessel in EUS-guided Coils and Cyanoacrylate Therapy for Gastric Varices

The Use of Angiography for Determination and Confirmation of the Feeder Vessel as a Modification of the Original EUS-guided Coils and Cyanoacrylate Therapy for Gastric Varices

efficacy will be considered be the complete occlusion and/or disappearance of the GV and will be determinate by follow-up controls using EUS and upper endoscopy. Treatment failure and early rebleeding will be considered when bleeding occurred the first five days.

all adverse events related to the technique during the procedure or the follow-up will be described.

Instituto Ecuatoriano de Enfermedades Digestivas

Liquid nitrogen spray cryotherapy with the truFreeze device

Liquid nitrogen spray cryotherapy with the truFreeze device
Liquid nitrogen spray cryotherapy with the truFreeze device: Low-pressure liquid nitrogen is sprayed through an upper endoscope on the diseased esophageal tissue to freeze and destroy it. The upper endoscope enables direct visualization of mucosal freeze during spray of the liquid nitrogen onto the mucosa and avoids the need for direct contact with the tissues. The target area is frozen and thawed for several consecutive cycles. The treated tissue becomes necrotic and sloughs, with new, healthy tissue regenerating in its place.

Cryotherapy

Sex: Female, Male

Race and Ethnicity Not Collected

The primary endpoint is to determine the response rate to spray cryotherapy.
It is hypothesized that one of the two following outcomes will occur:
Complete response to therapy: complete tumor eradication confirmed through histologic examination of biopsy specimens from the targeted esophageal tissue site;
Stable disease: tumor remission is not attained, but disease progression is halted.

Treated with liquid nitrogen spray cryotherapy

Treatment

Response Rate to Therapy

Disease-free Survival at 12 Months After Treatment

Cancer Recurrence Rate at 12 Months After Treatment

Estimate Overall Survival

Estimate Progression-free Survival in Those Who do Not Achieve Complete Pathologic Response

Number of Treatment Sessions Needed for Complete Response in Subjects in Whom the Primary Endpoint is Attained;

Number of participants with adverse events; Number of adverse events within the study

Safety of Spray Cryotherapy in This Setting;

Overall Study

Dr. Bruce Greenwald

Esophageal Cancer

Low-pressure liquid nitrogen is sprayed through an upper endoscope on the diseased esophageal tissue to freeze and destroy it. The upper endoscope enables direct visualization of mucosal freeze during spray of the liquid nitrogen onto the mucosa and avoids the need for direct contact with the tissues. The target area is frozen and thawed for several consecutive cycles. The treated tissue becomes necrotic and sloughs, with new, healthy tissue regenerating in its place.

esophageal stenosis/fever

Angiography for Evaluation of the Feeder Vessel in EUS-guided Coils and Cyanoacrylate Therapy for Gastric Varices

Spray Cryotherapy for Esophageal Cancer (ICE-CANCER)

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