Background:
Management of visceral pseudoaneurysm was forte of surgeons and interventional radiologists. With progressive development in the field of therapeutic endoscopic ultrasound, EUS guided coil and glue injection is emerging as widely accepted modality in these cases. We present a case series of 5 cases,presenting to us with GI bleed managed with EUS guided coil and glue injection.
Material and methods:
A total of 5 cases were managed in a single center study from June 2023 to September 2024. A prior CECT abdomen was done in all the cases to delineate anatomy of vascular and size of pseudoaneurysm. All procedures were done under general anaesthesia and under CO2 insufflation. Patients were in left lateral position. EUS was done on Olympus ME 3 processor and linear echoendoscope (GF-UCT180). The pseudoaneurysm were punctured with 19G needle(Boston scientific). Nester coil (Cook medicals)was used in all the cases. 2ml cyanoacrylate glue was injected after coil placement under EUS guidance. Follow up CECT abdomen was done in all the cases following day to confirm complete obliteration of pseudoaneurysm and to look for any glue embolisation. All patients were followed up every month following the procedure
Results:
All 5 patients were male with age ranging from 37 to 72years. Two patients had acute pancreatitis, 2 with recurrent pancreatitis and one had chronic pancreatitis. All patients presented with recurrent hemetemesis and melena. 3 patients had pseudoaneurysm arising from splenic artery, one with gastroduodenal artery and one from short gastric artery. The size of pseudoaneurysm varied from 1.8x 1.4cm (maximum) to 8 x 7 mm (minimum). Single coil was placed to obliterate the pseudoaneurysm in each case followed by 2ml of cyanoacrylate glue. Complete obliteration was achieved in all the cases confirmed and EUS power Doppler and CECT abdomen the following day. One patient developed a splenic infarct which was managed conservatively. None of the patients presented with recurrence of GI bleed.
Conclusion:
EUS guided coil and glue injection of management of visceral pseudoaneurysms is an excellent and safe alternative to conventional angiography and coiling.