Combined endoscopic ultrasound and conventional endoscopy improves outcomes in bleeding GOV2 and IGV1 gastric varices: A multicenter retrospective propensity-matched cohort study.

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2026-08-28 eCollection Date: 2026-01-01 DOI:10.1177/17562848261483777

Fangfang Yu, Zhihong Wang, Xuecan Mei, Wei Zhang, Mingkai Chen, Derun Kong

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引用次数: 0

Abstract

Background: Endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices (GVs) may leave residual untreated vessels due to incomplete visualization of distal collateral channels. Whether adding conventional endoscopic injection improves outcomes remains unclear.

Objectives: This multicenter retrospective study evaluated a combined EUS-guided and conventional endoscopic approach in patients with bleeding GOV2 or IGV1 varices.

Design: This retrospective study (February 2022-December 2024) included 141 cirrhotic patients with acute gastric variceal bleeding from three Chinese tertiary centers.

Methods: Patients received either EUS-guided therapy alone or combined therapy with supplementary conventional endoscopic injection per institutional practice. Propensity score matching (1:1) and multivariable Cox regression were used to reduce selection bias. Primary outcome was variceal rebleeding; secondary outcomes included technical success, variceal recurrence, reintervention, mortality, and adverse events.

Results: Technical success was achieved in all patients (100%). After matching, variceal recurrence rates were comparable between groups (5.36% vs. 12.50%, P = 0.185), whereas rebleeding occurred less frequently in the combination group than in the EUS group (7.14% vs. 25.00%, P = 0.010). This association appeared more pronounced in IGV1 varices (2.70% vs. 27.03%, P = 0.016), although the subgroup finding should be interpreted cautiously because the interaction test was not statistically significant. Reintervention was also less frequent in the combination group (12.50% vs. 35.71%, P = 0.004). Mortality and adverse event rates were comparable between groups.

Conclusion: Supplementary conventional endoscopic injection after EUS-guided therapy was associated with lower risks of rebleeding and reintervention without an apparent increase in adverse events. This combineds strategy may be a feasible option to improve treatment durability in selected patients with high-risk GOV2 or IGV1 gastric varices, but prospective randomized studies are needed for confirmation.

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内镜超声联合常规内镜可改善GOV2和IGV1胃静脉曲张出血的预后：一项多中心回顾性倾向匹配队列研究

背景：超声内镜（EUS）引导下的氰基丙烯酸酯注射治疗胃静脉曲张（GVs），由于远侧侧支通道的不完全可见，可能会留下未处理的残余血管。加入常规内镜注射是否能改善预后仍不清楚。目的：本多中心回顾性研究评估eus引导和常规内镜联合入路治疗GOV2或IGV1静脉曲张出血患者。设计：这项回顾性研究（2022年2月至2024年12月）纳入了141例来自中国三个三级中心的肝硬化急性胃静脉曲张出血患者。方法：根据机构实践，患者接受eus引导治疗或联合常规内镜注射辅助治疗。采用倾向评分匹配（1:1）和多变量Cox回归来减少选择偏差。主要结局为静脉曲张再出血；次要结局包括技术成功、静脉曲张复发、再干预、死亡率和不良事件。结果：所有患者均获得技术成功（100%）。配对后，两组间静脉曲张复发率相当（5.36%比12.50%,P = 0.185），而联合用药组再出血发生率低于EUS组（7.14%比25.00%,P = 0.010）。这种关联在IGV1静脉曲张中更为明显（2.70% vs. 27.03%, P = 0.016），尽管亚组发现应谨慎解释，因为相互作用试验没有统计学意义。联合治疗组再干预发生率也较低（12.50% vs. 35.71%, P = 0.004）。两组之间的死亡率和不良事件发生率具有可比性。结论：eus引导治疗后补充常规内镜注射与再出血和再干预风险较低相关，且不良事件没有明显增加。这种联合策略可能是一种可行的选择，以提高高风险GOV2或IGV1胃静脉曲张患者的治疗持久性，但需要前瞻性随机研究来证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.