Clip-assisted endoscopic cyanoacrylate injection vs endoscopic ultrasound-guided coil and cyanoacrylate injection for gastric varices: A propensity score-matched study.

BACKGROUND

The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage. Clip-assisted endoscopic cyanoacrylate injection (Clip-CYA) and endoscopic ultrasound-guided coil and cyanoacrylate injection (EUS-CG) are two currently used modalities. There are limited data comparing the two techniques.

AIM: To compare the efficacy, safety, and procedural characteristics of Clip-CYA vs EUS-CG for treatment of gastric varices (GVs) with spontaneous portosystemic shunts.

METHODS

Between April 2019 and August 2023, 162 patients with GVs and concomitant gastrorenal or splenorenal shunts who underwent either Clip-CYA or EUS-CG at our center were included. After 1:2 propensity score matching, 108 patients were included in the final analysis. The evaluated outcomes included the amount of cyanoacrylate, eradication of GVs, cyanoacrylate embolization, all-cause rebleeding, operating time and endoscopic therapy costs.

RESULTS

Of the 108 patients, 72 (male, 83.3%; mean age, 56.2 ± 10.8 years) received Clip-CYA, and 36 (male, 72.2%; mean age, 59.1 ± 10.7 years) received EUS-CG. The amount of cyanoacrylate used, rates of obliteration of GVs and all-cause rebleeding were similar between the two groups (2.0 ± 1.1 mL vs 2.0 ± 0.6 mL, P = 0.913; 91.7% vs 94.4%, P = 0.603; and 23.6% vs 19.4%, P = 0.623, respectively). No cyanoacrylate embolization occurred in either group. Compared with EUS-CG, Clip-CYA was associated with significantly shorter operating times (24.0 ± 9.9 minutes vs 47.1 ± 21.0 minutes, P < 0.001) and lower endoscopic therapy costs (7523.4 ± 5719.4 Chinese yuan vs 11153.7 ± 7679.1 Chinese yuan, P = 0.007). These advantages persisted in the subgroup analysis of patients whose GVs had a maximum diameter > 3 cm or > 4 cm.

CONCLUSION

Compared with EUS-CG, Clip-CYA of GVs appears to be a safe procedure with shorter operating times and lower endoscopic therapy costs.