Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic ultrasound-guided coil and glue embolization is superior to endoscopic cyanoacrylate glue injection for gastric varices: a propensity-matched analysis from India

  • Rajesh Puri (Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity) ;
  • Suprabhat Giri (Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences) ;
  • Zubin Dev Sharma (Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity) ;
  • Bimal Kumar Sahu (Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity)
  • Received : 2025.09.17
  • Accepted : 2025.11.17
  • Published : 2026.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Endoscopic cyanoacrylate glue injection (END-G) is the recommended therapy for gastric varices; however, endoscopic ultrasound-guided coil and glue embolization (EUS-C+G) is increasingly utilized. This study compared the efficacy and safety of END-G and EUS-C+G. Methods: We retrospectively analyzed patients with gastric varices who underwent variceal obliteration. Propensity score matching (1:1) was used to balance baseline variables. The primary outcome was variceal obliteration at 4 weeks, and the secondary outcomes included adverse events (AEs), bleeding, ascites, and mortality. Predictors of incomplete obliteration were assessed using END-G. Results: A total of 442 patients were included. In the matched cohort (n=71/group), EUS-C+G achieved higher obliteration rates than those of END-G (95.8% vs. 64.8%, p<0.001) with a low glue volume (median 1.5 mL vs. 2.5 mL, p<0.001). AEs were more frequent with EUS-C+G (25.4% vs. 8.5%, p=0.007), although they were generally mild and managed conservatively. The rates of bleeding, ascites, and 4-week mortality were similar between groups. Subgroup analysis showed the superiority of EUS-C+G in patients with isolated fundal varices (93.1% vs. 50.0%) and in secondary prophylaxis (95.0% vs. 53.3%), although with high AEs. Portal vein thrombosis (odds ratio, 154.086) and a varix size ≥18 mm (odds ratio, 2.664) predicted incomplete obliteration with END-G. Conclusions: EUS-C+G provides superior short-term obliteration compared with END-G, although with increased but milder AEs. Careful patient selection and expertise are essential.

Keywords

References

  1. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology 2004;126:1175–1189. https://doi.org/10.1053/j.gastro.2004.01.058
  2. Goral V, Yılmaz N. Current approaches to the treatment of gastric varices: glue, coil application, TIPS, and BRTO. Medicina (Kaunas) 2019;55:335. https://doi.org/10.3390/medicina55070335
  3. Saraswat VA, Verma A. Gluing gastric varices in 2012: lessons learnt over 25 years. J Clin Exp Hepatol 2012;2:55–69. https://doi.org/10.1016/S0973-6883(12)60088-7
  4. Rai P, Kumar P, Hoda US, et al. Endoscopic ultrasound-guided vascular interventions: a review (with videos). Indian J Gastroenterol 2024;43:927–942. https://doi.org/10.1007/s12664-024-01681-4
  5. Khare S, Arora A, Varghese J. Safety and efficacy of novel cost-effective EUS coiling and glue technique for the management of large gastric varices: a long-term follow-up study. J Dig Endosc 2024;15:222–227.
  6. Giri S, Jearth V, Seth V, et al. Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: a systematic review and network meta-analysis. Clin Exp Hepatol 2023;9:57–70.
  7. Patel RK, Tripathy T, Chandel K, et al. Left-sided portal hypertension: what an interventional radiologist can offer? Eur Radiol 2025;35:2530–2542. https://doi.org/10.1007/s00330-024-11196-3
  8. Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2022;54:1094–1120. https://doi.org/10.1055/a-1939-4887
  9. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII: renewing consensus in portal hypertension. J Hepatol 2022;76:959–974. https://doi.org/10.1016/j.jhep.2021.12.022
  10. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446–454. https://doi.org/10.1016/j.gie.2009.10.027
  11. Trikudanathan G, Rahimi EF, Bhatt A, et al. Endoscopic devices and techniques for the management of gastric varices (with videos). Gastrointest Endosc 2025;101:496–510. https://doi.org/10.1016/j.gie.2024.06.038
  12. Lôbo MRA, Chaves DM, DE Moura DTH, et al. Safety and efficacy of EUS-guided coil plus cyanoacrylate versus conventional cyanoacrylate technique in the treatment of gastric varices: a randomized controlled trial. Arq Gastroenterol 2019;56:99–105. https://doi.org/10.1590/s0004-2803.201900000-08
  13. Jhajharia A, Yadav S, Singh S, et al. Endoscopic ultrasonography-guided coil embolization and cyanoacrylate injection versus cyanoacrylate injection alone for gastric varices: a randomized comparative study. Endoscopy 2025;57:107–115. https://doi.org/10.1055/a-2408-6905
  14. Florencio de Mesquita C, Antunes VLJ, Milioli NJ, et al. EUS-guided coiling plus glue injection compared with endoscopic glue injection alone in endoscopic treatment for gastric varices: a systematic review and meta-analysis. Gastrointest Endosc 2025;101:331–340. https://doi.org/10.1016/j.gie.2024.10.005
  15. Xiaoqing Z, Na L, Lili M, et al. Endoscopic cyanoacrylate injection with Lauromacrogol for gastric varices: long-term outcomes and predictors in a retrospective cohort study. J Laparoendosc Adv Surg Tech A 2019;29:1135–1143. https://doi.org/10.1089/lap.2019.0360
  16. Chavan R, Baraldo S, Patel N, et al. Technical tips for EUS-guided embolization of varices and pseudoaneurysms. VideoGIE 2024;9:211–219.
  17. Puri R, Sharma ZD, Patle S, et al. EUS coil and glue for gastric varices-prevent, treat and rescue, one therapy to rule them all? Endosc Ultrasound 2024;13:35–39.
  18. Huang Z, Zhang W, Lv F, et al. Efficacy and safety of EUS-guided coil embolization combined with endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration for gastric varices with high-risk ectopic embolism: a multicenter and retrospective cohort study. Endosc Ultrasound 2023;12:74–83. https://doi.org/10.4103/EUS-D-21-00260
  19. Giri S, Patel RK, Chavan R, et al. Endoscopic ultrasound-guided therapies versus retrograde transvenous obliteration for gastric varices: multicenter propensity matched analysis. Endosc Int Open 2025;13:a25491165. https://doi.org/10.1055/a-2549-1165