Objective To describe the feasibility and outcomes of endoscopic ultrasound (EUS) in the treatment of gastric variceal bleeding secondary to sinistral portal hypertension (SPH). Methods A retrospective analysis was performed on patients with gastric variceal bleeding secondary to SPH who received EUS-guided treatment at Beijing Ditan Hospital, Capital Medical University from January 2021 to May 2025. Clinical data of the enrolled patients were retrospectively reviewed to evaluate the therapeutic effect of EUS-guided intervention for gastric varices (GVs), including variceal obliteration and recurrence, as well as early and late rebleeding events. Results A total of four patients with SPH complicated with gastric variceal bleeding underwent EUS-guided treatment, including two males and two females, with a mean age of 35.8 years. The underlying cause was splenic vein occlusion, which was secondary to chronic pancreatitis in three patients and to a pancreatic mass in one patient. Surveillance endoscopy and contrast-enhanced computed tomography (CECT) performed at 3 months after treatment showed substantial reduction of gastric fundal varices in three patients, who subsequently completed telephone follow-up at 6 months and 1 year. No rebleeding occurred in these three patients. One female patient declined surveillance gastroscopy. 1 year post-procedure, she developed recurrent gastric variceal bleeding during the second trimester (15 weeks of gestation). No further bleeding was observed after endoscopic hemostasis. She underwent splenectomy half a year following uneventful delivery. Conclusion EUS-guided therapy appears feasible for the management of gastric variceal bleeding secondary to SPH, particularly in patients with poor general status who are intolerant to or decline surgical treatment.
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Ye et al. (2026) studied this question.