金属夹辅助内镜超声引导组织胶注射治疗合并胃肾分流的肝硬化胃静脉曲张患者的效果初探OACSTPCD

Objective To investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt(GRS).Methods The patients who attended Beijing Ditan Hospital,Capital Medical University,due to liver cirrhosis and gastric varices from February to June 2023 were enrolled,and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips.The primary evaluation index was alleviation or disappearance of varicose veins after surgery,and the secondary evaluation indices were surgical completion and complications.Results A total of 11 patients were enrolled in this study,among whom there were 7 male patients and 4 female patients,with a median age of 55 years.Of all patients,1 had Child class A liver function,7 had Child class B liver function,and 3 had Child class C liver function.The maximum(median)diameter of the shunt was 8 mm,and the minimum(median)diameter of the shunt was 4 mm.The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips.The median amount of tissue adhesive injected was 2 mL,and the amount of lauromacrogol used was 1 mL.Disappearance of blood flow signals was observed in all patients after surgery(100%),and the success rate of surgery was 100%.No patient experienced rebleeding after follow-up for 6 weeks.Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients.Conclusion Endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible,safe,and effective treatment method for cirrhotic patients with gastric varices and GRS.