EUS-guided vascular therapy: an effective approach for refractory and per-endoscopic non-variceal gastrointestinal bleeding

Background: Endoscopic ultrasound (EUS) offers transparietal access to vascular structures, enabling localized treatment. Few studies have been published about EUS-guided vascular therapy, with a limited number of patients, especially in non-variceal bleeding. We present our results in this setting. Objectives: The primary objective was to evaluate the efficacy of EUS-guided vascular embolization, defined as the disappearance of both Doppler signal and bleeding. Secondary objectives were to document adverse events (AGREE classification), the rate of recurrences, and their management. Design: This was a single-center retrospective observational study. Methods: All patients included underwent EUS-guided vascular embolization for spontaneous or intraoperative non-variceal GI bleeding, using acrylic bioglue with Lipiodol as embolizing agent. Results: A total of 42 patients, aged between 31 and 88 years, were included (median 67.5). The origin of the bleeding was spontaneous on a pre-existing lesion in 59.5% of cases, and consecutive to an endoscopic procedure in 40.5% of cases. Initial technical and clinical success rates were 100%. No major adverse event was observed. Seven patients (16.7%) experienced a bleeding recurrence, with a median delay of 42 days [2–127], all in the spontaneous group. Five were managed by a second EUS-guided embolization, and one had a third recurrence managed surgically. Conclusion: This study underlines the major value of EUS-guided vascular approach in the treatment of recurrent and complex, as well as intraoperative GI bleedings, showing a high efficacy rate and good safety profile. Improvements in embolization techniques and devices would further democratize the procedure.