Clip-assisted therapy versus EUS-guided coil embolization for secondary prophylaxis of isolated gastric varices: A multicenter study.

Abstract

Background and objectives: Bleeding from isolated gastric varix type I (IGV1) is less common but more dangerous and fatal than other varices. This study compared the safety and efficacy of endoscopic clipping and cyanoacrylate injection (EC-CYA) with EUS-guided coil and cyanoacrylate injection (EUS-coil/CYA) in the secondary prophylaxis of IGV1.

Methods: A retrospective study was conducted on 131 patients with cirrhosis and a history of IGV1 bleeding who underwent either EC-CYA (n = 55) or EUS-coil/CYA (n = 76) at three medical centers. Primary outcomes were gastric variceal rebleeding and ectopic embolism. Secondary outcomes were technical success, variceal obliteration rate, cyanoacrylate volume, cyanoacrylate embolization efficiency, other causes of rebleeding, other adverse events, and mortality.

Results: In the EC-CYA group, the gastric variceal rebleeding rate (14.5% vs. 8.7%, P = 0.307), technical success rate (96.4% vs. 94.7%, P > 0.999), other causes of rebleeding rate (12.7% vs. 5.8%, P = 0.303), other adverse events rate (5.5% vs. 5.8%, P > 0.999), and mortality (12.7% vs. 8.7%, P = 0.467) showed no significant differences compared with the EUS-coil/CYA group. No ectopic embolism was found in either group. The EC-CYA group had a higher cyanoacrylate volume (3.14 ± 1.45 mL vs. 1.99 ± 0.72 mL, P < 0.001) and a higher variceal obliteration rate at first follow-up (82.23% ± 27.09% vs. 66.59% ± 30.28%, P = 0.032). However, the EUS-coil/CYA group was superior to the EC-CYA group in terms of cyanoacrylate embolization efficiency (2.85 ± 2.05 cm²/mL vs. 1.98 ± 1.46 cm²/mL, P = 0.044).

Conclusions: Both EC-CYA and EUS-coil/CYA are safe and effective in preventing rebleeding of IGV1. The EUS-coil/CYA has better embolization efficiency, whereas EC-CYA has better operational convenience.