Gastrointestinal endoscopy · 2026
Endoscopic ultrasound-guided coils embolization with cyanoacrylate injection versus transjugular intrahepatic portosystemic shunt with variceal embolization for gastric variceal bleeding: a multicenter propensity-matched analysis.
СтатьяМногоцентровое исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wang Zhihong, Li Huixian, Zeng Zhuang, Zhang Wei, Mei Xuecan, Bai Yuchuan, Zhang Qianqian, Ma Chao, Chen Hongtan, Kong Derun
Аннотация
BACKGROUND AND AIMS: Gastric variceal bleeding (GVB) carries high mortality, and conventional endoscopy offers limited efficacy. This study aimed to evaluate the efficacy and safety of EUS-guided coils embolization combined with cyanoacrylate injection (EUS-Coils+CYA) versus transjugular intrahepatic portosystemic shunt combined with variceal embolization (TIPS+VE) in patients with GVB.
METHODS: This multicenter retrospective study used a propensity score-matching (PSM) analysis. The primary outcomes were technical success rate, recurrent bleeding rate, and mortality rate.
RESULTS: Of the 187 initially enrolled patients with cirrhosis and GVB, 124 were matched (62 per group). After 1:1 PSM, 124 patients were analyzed (62 in the EUS-Coils+CYA group and 62 in the TIPS+VE group). The technical success rate was 100% in both groups. No significant differences were found in the overall recurrent bleeding rate (11.29% vs 9.68%; P = .769) or mortality rate (4.84% vs 1.61%; P = .611). Regarding other adverse events, the TIPS+VE group had a higher incidence of postprocedural abdominal pain and overall hepatic encephalopathy (HE) than the EUS-Coils+CYA group (14.52% vs 1.61%; P = .008; 14.52% vs 1.61%; P = .008). Multivariate analysis identified the treatment method as a factor associated with HE development (hazard ratio = 8.84; 95% CI, 1.12-69.79; P = .039). Conversely, the incidence of ectopic embolism (all pulmonary embolisms) was higher in the EUS-Coils+CYA group than in the TIPS+VE group (9.68% vs 0%; P = .036).
CONCLUSIONS: EUS-Coils+CYA and TIPS+VE showed comparable outcomes in controlling gastric varix recurrent bleeding and survival. Patients treated with EUS-Coils+CYA had a lower incidence of HE but carried a risk of ectopic embolism.
METHODS: This multicenter retrospective study used a propensity score-matching (PSM) analysis. The primary outcomes were technical success rate, recurrent bleeding rate, and mortality rate.
RESULTS: Of the 187 initially enrolled patients with cirrhosis and GVB, 124 were matched (62 per group). After 1:1 PSM, 124 patients were analyzed (62 in the EUS-Coils+CYA group and 62 in the TIPS+VE group). The technical success rate was 100% in both groups. No significant differences were found in the overall recurrent bleeding rate (11.29% vs 9.68%; P = .769) or mortality rate (4.84% vs 1.61%; P = .611). Regarding other adverse events, the TIPS+VE group had a higher incidence of postprocedural abdominal pain and overall hepatic encephalopathy (HE) than the EUS-Coils+CYA group (14.52% vs 1.61%; P = .008; 14.52% vs 1.61%; P = .008). Multivariate analysis identified the treatment method as a factor associated with HE development (hazard ratio = 8.84; 95% CI, 1.12-69.79; P = .039). Conversely, the incidence of ectopic embolism (all pulmonary embolisms) was higher in the EUS-Coils+CYA group than in the TIPS+VE group (9.68% vs 0%; P = .036).
CONCLUSIONS: EUS-Coils+CYA and TIPS+VE showed comparable outcomes in controlling gastric varix recurrent bleeding and survival. Patients treated with EUS-Coils+CYA had a lower incidence of HE but carried a risk of ectopic embolism.