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Introduction

Ectopic varices are not very common but complicate 2 to 5 % cases of variceal bleeding. Management options include interventional radiology (IR) modalities like BRTO or TIPS, EUS guided treatment, endoscopic sclerotherapy and endoscopic cyanoacrylate glue injection. Not much data is available with endoscopic cyanoacrylate glue injections. IR modalities are expensive and usually unavailable in most centres in emergent conditions. We hereby share our experience of using only cyanoacrylate glue in the management of ectopic varices.

Aims & Methods

We retrospectively analysed data of patients admitted with variceal bleed from January 2008 to October 2024. Ectopic (duodenal and jejunal) varices were found in 31 patients. Out of these only 26 patients required endotherapy for ectopic varices. The ectopic varices were injected using aliquots of 0.5ml of cyanoacrylate glue followed by 2ml to 2.5ml of distilled water for flushing the needle. No lipiodol was used.

Results

The mean age of the patient was 43.8 + 3.4 years. 18 patients were male. Extrahepatic portal venous obstruction (EHPVO) was the most common disease and was found in 26 patients, while 5 patients had cirrhosis. Aetiology of cirrhosis was hepatitis C in 3 patients, autoimmune hepatitis in 1 patient and alcohol in 1 patient. 20 (76.9%) patients had history of prior endotherapy for esophageal or gastric varices. 23 patients had concomitant esophageal varices. 7 patients had concomitant GOV1 varices. 3 patients had concomitant GOV2 and 9 patients had concomitant IGV1. The varices were located in D1:D2:D3,4:proximal jejunum in 12:14:4:1 patients respectively. In 21 patients red colour signs or stigmata of recent haemorrhage were found and were treated. Of the 12 patients not treated in in index endoscopy, 5 patients had subsequent bleed from duodenal varices and treated. Haemostasis could be achieved in all patients. Two patients had severe bleed from puncture site which was controlled with further glue injections. Mean amount of glue used was 1.35 (0.5 to 4 ml). 2 patients had rebleed within 4 weeks of endotherapy, one required TIPSS and one required BRTO. Mean hospital stay was 2.7 days (2 to 7 days). Long term follow up was available in 27 patients and in 24 out of 26 patients who underwent endotherapy. Glue extrusion was noted in 10 (38.4%) and rest revealed good thrombosis only. All patients were alive without further episode of rebleed. No EUS guided procedure was needed in any of our cases. No embolism was noted.

Conclusion

Cyanoacrylate glue injections are a very effective modality in the management of bleeding from ectopic varices with very few adverse events. We need to prospectively study the efficacy of cyanoacrylate glue in ectopic varices comparing it other modalities.

IS CYANOACRYLATE GLUE THE ANSWER IN MANAGEMENT OF ECTOPIC DUODENAL AND JEJUNAL VARICES?

Pankaj Desai 1, Chintan Patel 2, Mayank V Kabrawala 2, Ritesh Prajapati 2, Mohit Sethia 2, Nisharg Patel 2

1 SIDS Hospital & Research Centre, Surat, India

2 SIDS Hospital & Research Institute, Surat, India

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Difficult stones: Is it the stone or the endoscopist?

Andrea Anderloni 1

1 San Matteo Hospital, Pavia, Italy

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary

Session

Crash course: Tough endoscopists for tough stones

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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EUS guided therapeutic procedures

Roy LJ van Wanrooij 1

1 Amsterdam UMC, Amsterdam, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Is there really an added value for all new EUS/ERCP techniques?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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ESGE Live Endoscopy I (Complete Session)

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

ESGE Live Endoscopy I

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Latest developments in ERCP

Aurelio Mauro 1

1 IRCCS Foundation San Matteo Hospital, Pavia, Italy

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Is there really an added value for all new EUS/ERCP techniques?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Early versus delayed endoscopic necrosectomy (Complete Session)

Event

UEG Week Berlin 2025

Topics

Endoscopy

Session

Early versus delayed endoscopic necrosectomy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Managing biliopancreatic disease in elderly patients is a growing challenge, where the balance between benefit and risk becomes increasingly delicate. ERCP remains a fundamental tool, but its application in older adults requires individualized technical and clinical considerations. The aim of our study was to evaluate the characteristics of elderly patients who underwent ERCP.

Aims & Methods

We conducted a retrospective descriptive study from January 2019 to January 2025, including all patients aged ≥65 years who underwent ERCP. Collected data encompassed demographic characteristics, clinical presentation, procedural indications, technical success, therapeutic approaches, and procedure-related complications.

Results

We recorded 186 patients : 62.36% women (n=116) and 37.6% men (n=70), with a median age of 75 years [IQR: 71–80]. The most frequent presenting symptoms were biliary colic (43.4%, n=79), acute cholangitis (23.6%, n=43), cholestatic jaundice (11.8%, n=22), and acute pancreatitis (10.8%, n=20).
ERCP was indicated for benign pathology in the majority of cases, primarily for choledocholithiasis (56.5%, n=104). Other benign etiologies (11%, n=12) included post-cholecystectomy syndrome, biliary pancreatitis, bile duct injury, and Sump syndrome.
Malignant indications included pancreatic head tumors (20.7%, n=38), hilar cholangiocarcinoma (7.1%, n=13), ampullary carcinoma (6.5%, n=12), and gallbladder carcinoma (3.8%, n=7).
The technical success rate for benign pathology was 97.4% (n=113), with a failure rate of 2.6% (n=3). In malignant indications, the success rate was 90% (n=63), with failures (10%, n=7) primarily due to duodenal obstruction or an intradiverticular papilla.
Stenting strategies included uncovered self-expandable metal stents (33.2%, n=43), covered metal stents (3.8%, n=7), and plastic stents (7.6%, n=14).
Intra-procedural bleeding following sphincterotomy occurred in 2.7% of cases (n=3); two were managed with epinephrine injection and one with hemostatic clipping. No delayed post-procedural complications were reported.

Conclusion

ERCP appears to be a safe, effective, and well-tolerated procedure in elderly patients. When guided by appropriate indications and expert technique, age does not represent a limitation but rather a parameter requiring adapted procedural planning.

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE ELDERLY

Houda Chehboune 1, FATIMA-ZAHRA CHABIB 1, Maryeme Kadiri 2, Nawal Lagdali 3, Fatima Zahra Ajana 4, Mohamed Borahma 3

1 Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

2 Ibn Sina Hospital, Rabat, Morocco

3 Mohammed the Vth University, Ibn Sina Hospital, Rabat, Morocco

4 CHU Ibn Sina, Rabat, Morocco

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

BILIARY (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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