Endoscopic ultrasound-guided diagnosis and treatment of gastric varices

Table 1 Endoscopic ultrasound-guided diagnosis and treatment of gastric varices

EUS application	Potential benefits	Areas of concern	Ref.
Diagnosis
Accurate identification	Improving diagnostic sensitivity and differential diagnosis; real-time	-	[21-27]
Preprocedural evaluation	Predicting bleeding risk and determining treatment; reproducible and non-invasive	-	[29-32]
Therapeutic evaluation	Improving real-time monitoring and repeated injection management; safer and more objective	-	[5,8,26,33-36]
Treatment
EUS-guided sclerotherapy	Reducing injection dose, complications, and recurrence	Inferior to cyanoacrylate	[47-49]
EUS-guided tissue adhesive injection	Reducing injection dose, rebleeding rate and complications; faster and more firmly	Lack of recommended procedures and comparison among different needles	[36,41,42,51,54-59]
EUS-guided coil embolization	Improving technical success and reducing interventions and complications	Additional radiation exposure; expensive; technically demanding	[36,40,60-64]
EUS-guided coil embolization combined with tissue adhesive injection	Improving variceal occlusion, reducing rebleeding and reinterventions	Not clear about optimal coil numbers; technically challenging and time-consuming	[7,35,65-68]
Other EUS-guided injections	Novel alternatives; high clinical success rates with low risk for complications	Inferior variceal obliteration efficacy; lack of controlled studies	[40,69-72]
EUS-guided endovascular treatments	No radiation exposure; shorter puncture path; promising alternatives	Lack of controlled studies	[6,74-78]

EUS: Endoscopic ultrasound.