Endoscopic ultrasound–guided coil embolization and absorbable hemostatic gelatin sponge is a safe and efficacious treatment for bleeding rectal varices

Background and Aims: Rectal variceal bleeding is a rare life-threatening cause of lower gastrointestinal bleeding. We present the first case series to our knowledge of successful hemostasis achieved with combination of endoscopic ultrasound (EUS)-guided coil embolization and absorbable gelatin sponge (AGS) for bleeding rectal varices. Methods: We performed a retrospective review of 6 patients with active rectal variceal bleeding. All patients underwent EUS-guided coil embolization with AGS therapy. Procedural details, technical success, adverse events, and rebleeding rates were measured. Results: We achieved 100% technical success (6 of 6 patients) with successful sonographic rectal varices decompression. A range of 1 to 4 coils with a total length of 7 to 20 cm was injected along with AGS. There were no adverse events or rebleeding from recurrent rectal varices. Median follow-up period was 190 days. Conclusions: EUS-guided coiling coupled with AGS therapy appears to be a potentially safe and efficacious alternative for patients with bleeding rectal varices.