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Hemorrhage is the most frequent (30– 40%) and dangerous complication of gastrointestinal stromal tumors (GISTs), with surgery being the treatment of choice and emergency surgery having a significantly higher risk than elective procedures [1]. Conventional endoscopic treatment of tumoral lesions is challenging and efficacy limited because of the complex neoangiogenesis of these lesions, which are beyond the reach of endoscopic contact procedures [2]. Cases of endoscopic ultrasound (EUS)guided therapy of bleeding GISTs with injection of cyanoacrylate (CYA) [3, 4] or ethanol [5] have been published. To the best of our knowledge, EUS-guided coil deployment has not been reported in this setting. We present two cases of bleeding GISTs successfully treated with EUS-guided combined coil deployment and further injection of CYA targeting the feeding artery (▶Video 1). Case 1: a 72-year-old man was admitted for melena and hemodynamic instability. An ulcerated fundic mass with a necrotic center and a 5-mm intratumoral artery was observed (▶Fig. 1). EUS-guided injection of CYA (Histoacryl; B. Braun, Melsulgen, Germany) into the feeding artery (▶Fig. 2) with a 22-gauge needle was the initial approach. However, a spurting bleed into the tumor cavity after punction was observed (▶Fig. 3). Hemostasis was achieved by deploying a 6-mm×20cm coil (Nester; Cook Medical, Limerick, Ireland) and injecting 2mL of CYA with a 19-gauge needle (▶Fig. 4). E-Videos

Endoscopic ultrasound-guided angiotherapy in bleeding gastrointestinal stromal tumors with coil deployment and cyanoacrylate injection