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EUS-guided vascular interventions: Fact or Fancy?

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Dr Kenneth Binmoeller, California    05 December 2018

  • What does EUS add to endoscopy-guided therapy?
  1. Detect vessel lumen, confirm blood flow
  2. Target “feeder” vessel
  3. Control delivery of treatment
  4. Confirm treatment success
  5. Treat without endoscopic visualization.
  • EUS-guided portal angiotherapy
  1. Applications: Portal pressure gradient, portal injection chemotherapy, portosystemic shunt.
  • The goal of EUS-guided portal injection chemotherapy is to optimize liver levels and minimize systemic levels of chemotherapy.
  • EUS-guided portosystemic shunt: Direct access to liver vessels from stomach.
  • Fact (in current clinical use):
  1. Refractory bleeding when endoscopic treatment fails
  2. EUS-guided coil + glue for fundal varices
  3. Portal pressure gradient measurements.
  • Fancy (animal studies only):
  1. EPIC: Portal injection chemotherapy
  2. Portosystemic shunt
  3. Infusion thrombolysis
  4. Coil embolization for lobe hypertrophy.

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