Management of parastomal variceal bleeding with endoscopic ultrasound–guided coiling and human thrombin/fibrinogen injection

Sanjeevani Tomar; Abdullah Abbasi; Saurabh Chandan; Sagar J. Pathak; Deepanshu Jain; Kambiz K. Kadkhodayan; Muhammad K. Hasan; Mustafa A. Arain

doi:10.1016/j.vgie.2025.11.012

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Management of parastomal variceal bleeding with endoscopic ultrasound–guided coiling and human thrombin/fibrinogen injection

Journal article

Open access

Peer reviewed

Management of parastomal variceal bleeding with endoscopic ultrasound–guided coiling and human thrombin/fibrinogen injection

Sanjeevani Tomar, Abdullah Abbasi, Saurabh Chandan, Sagar J. Pathak, Deepanshu Jain, Kambiz K. Kadkhodayan, Muhammad K. Hasan and Mustafa A. Arain

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, Vol.11(5), pp.191-194

05/01/2026

DOI: 10.1016/j.vgie.2025.11.012

PMCID: PMC13153903

PMID: 42109629

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Abstract

Parastomal varices are an uncommon but serious cause of gastrointestinal bleeding in patients with portal hypertension. Conventional treatments include surgical revision or interventional radiology embolization, but these may not be feasible in advanced disease. Endoscopic ultrasound (EUS)–guided therapy offers a minimally invasive alternative. We describe two cases using EUS-guided coiling and combined thrombin/fibrinogen injection for parastomal variceal bleeding. Two patients with colorectal cancer and prior liver metastases developed recurrent bleeding from parastomal varices despite conservative or interventional radiology management. Feeding vessels were identified by EUS, accessed with a 19-gauge needle, and treated with intravascular coil embolization followed by injection of thrombin/fibrinogen. Both procedures were technically successful without intraprocedural complications. Doppler confirmed near-complete obliteration of variceal flow. One patient remained free of recurrence, while the second required repeat treatment 2.5 months later, at which time cyanoacrylate glue was selected for definitive hemostasis. EUS-guided coiling with thrombin/fibrinogen injection appears to be a safe and effective option for achieving hemostasis in parastomal varices. Its minimally invasive nature and ability to directly target variceal inflow make it a promising alternative when conventional therapies are not feasible. Larger studies are needed to evaluate predictors of durable success and long-term outcomes.

Coil embolization

EUS

EUS-guided therapy

Fibrinogen

Interventional endoscopy

Minimally invasive

Parastomal varices

Portal hypertension

Thrombin injection

Variceal bleeding

Details

Title: Subtitle: Management of parastomal variceal bleeding with endoscopic ultrasound–guided coiling and human thrombin/fibrinogen injection
Creators: Sanjeevani Tomar - AdventHealth Orlando
Abdullah Abbasi - University of Iowa
Saurabh Chandan - Methodist West Hospital
Sagar J. Pathak - Loma Linda University
Deepanshu Jain - AdventHealth Orlando
Kambiz K. Kadkhodayan - AdventHealth Orlando
Muhammad K. Hasan - AdventHealth Orlando
Mustafa A. Arain - AdventHealth Orlando
Resource Type: Journal article
Publication Details: VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, Vol.11(5), pp.191-194
DOI: 10.1016/j.vgie.2025.11.012
PMID: 42109629
PMCID: PMC13153903
NLM abbreviation: VideoGIE
ISSN: 2468-4481
eISSN: 2468-4481
Publisher: Elsevier Inc
Alternative title: Management of Parastomal Variceal Bleeding with EUS-Guided Coiling and Human Thrombin/Fibrinogen Injection Thrombin/Fibrinogen Injection for Parastomal Varices
Language: English
Electronic publication date: 11/29/2025
Date published: 05/01/2026
Academic Unit: Internal Medicine
Record Identifier: 9985090586402771

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