Endoscopic ultrasound-guided left gastric vein embolization for esophageal and gastric varices in liver cirrhosis

Rationale: Conventional endoscopic ultrasound (EUS)-guided therapy for upper gastrointestinal varices mainly fills the variceal lumen without interrupting the feeding vessels, and recurrence remains common. We report a case in which EUS-guided embolization of the left gastric vein, the varices feeding vessel, was performed for esophageal and gastric varices. Patient concerns: A 47-year-old man with decompensated cirrhosis presented with hematemesis and melena. Diagnosis: Contrast-enhanced abdominal computed tomography showed decompensated cirrhosis with portal hypertension. Upper gastrointestinal endoscopy revealed esophageal varices extending below the cardia, 1.5 to 2 cm in diameter and consistent with gastroesophageal varices type 1, with red color signs. Laboratory findings included hemoglobin 57 g/L, albumin 28.8 g/L, and prothrombin time 18.7 seconds. Interventions: Endoscopy showed gastroesophageal varices type 1. EUS identified multiple perforating veins, all originating from the left gastric vein (LGV). The LGV was punctured with a 22-gauge needle, followed by deployment of an 8-mm coil and injection of 30 mL Lauromacrogol into the adjacent para-esophageal vein. Outcomes: Blood flow in the LGV was abolished, and the flow velocity within the esophageal varices decreased from 7 to 0–1 cm/s. No rebleeding or adverse events occurred during 4 months of follow-up, and endoscopy confirmed marked attenuation of the varices. Lessons: EUS-guided coil embolization of the LGV is feasible, safe, and effective for esophageal and gastric varices in cirrhosis and warrants evaluation in larger studies.