TIPS versus endoscopic cyanoacrylate injection for the treatment of gastric fundal variceal rebleeding: a propensity score-matched retrospective cohort study.

Background: The optimal strategy for preventing rebleeding with gastroesophageal varices type 2 (GOV2) and isolated gastric varices type 1 (IGV1) is unclear. In this retrospective study, we aimed to compare the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic cyanoacrylate injection (ECI) on GOV2 and IGV1 varices.

Methods: In this retrospective cohort study, we collected data from patients with cirrhosis with GOV2 and IGV1 varices who received TIPS or ECI treatment between June 2018 and June 2023. The primary endpoint was rebleeding, and the secondary endpoints were death and overt hepatic encephalopathy (OHE). Propensity score matching (PSM) and adjusted survival curves were used to assess the robustness of the results.

Results: A total of 111 eligible patients were included, of whom, 35 patients received TIPS and 76 patients received ECI. The median follow-up time for the TIPS and ECI groups were 746 and 683 days, respectively. TIPS reduced the all-cause rebleeding rate (14.3% versus 33.8%, p = 0.033; after PSM, 16.7% versus 40.0%, p = 0.045) compared with ECI, with lower risk of ectopic embolism (all were in the ECI group). The Incidence of OHE in the TIPS group was higher than that in the ECI group (28.6% versus 1.4%, p < 0.001; after PSM, 33.3% versus 3.3%, p < 0.001). However, no significant difference was found in mortality (17.1% versus 12.2%, p = 0.684; after PSM, 16.7% versus 16.7%, p = 1.000). The results were not affected by the adjusted survival curve.

Conclusion: TIPS was more effective than ECI in preventing rebleeding in patients with GOV2 and IGV1 varices with similar survival rates and lower risk of ectopic embolism, although TIPS was associated with a higher incidence of OHE.