European journal of gastroenterology & hepatology · 2026
Portal venous system thrombosis after cyanoacrylate injection for gastric varices under endoscopic ultrasound versus conventional endoscopy: a propensity-matched study.
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He Yingying, Wang Zhihong, Liao Yuxin, Ma Wanyu, Yang Xu, Kong Derun
Аннотация
OBJECTIVE: To compare the incidence of portal venous system thrombosis (PVST) following endoscopic ultrasound-guided cyanoacrylate injection (EUS-CYA) versus direct endoscopic cyanoacrylate injection (DEI-CYA) for gastric varices, and to identify associated risk factors.
METHODS: A total of 202 patients with cirrhosis who underwent either EUS-CYA or DEI-CYA for gastric varices were retrospectively enrolled. All patients were followed for at least 1 year after the procedure, and early PVST was assessed 3-5 months post-procedure. Propensity score matching was performed to balance baseline characteristics. The early and overall incidence of PVST was compared between groups, and an extended Cox proportional hazards model was used to identify risk factors.
RESULTS: After matching, 132 patients were included (66 per group). The incidence of post-procedural early PVST was significantly higher in the EUS-CYA group than in the DEI-CYA group (16.7% vs. 4.5%, hazard ratio = 3.62, P = 0.035), while overall PVST during follow-up showed no difference (22.7% vs. 16.7%, P = 0.340). Cumulative endoscopic treatment sessions [hazard ratio = 1.98, 95% confidence interval (CI) = 1.36-2.89, P < 0.001], D-dimer (hazard ratio = 1.10, 95% CI = 1.02-1.20, P = 0.015), and white blood cell count (hazard ratio = 0.87, 95% CI = 0.77-0.98, P = 0.024) were independently associated with PVST.
CONCLUSION: EUS-CYA was associated with an increased risk of early PVST. Enhanced imaging surveillance, particularly 90-130 days after the procedure, is warranted. Cumulative endoscopic treatment sessions, D-dimer, and white blood cell count are independently associated with the development of PVST.
METHODS: A total of 202 patients with cirrhosis who underwent either EUS-CYA or DEI-CYA for gastric varices were retrospectively enrolled. All patients were followed for at least 1 year after the procedure, and early PVST was assessed 3-5 months post-procedure. Propensity score matching was performed to balance baseline characteristics. The early and overall incidence of PVST was compared between groups, and an extended Cox proportional hazards model was used to identify risk factors.
RESULTS: After matching, 132 patients were included (66 per group). The incidence of post-procedural early PVST was significantly higher in the EUS-CYA group than in the DEI-CYA group (16.7% vs. 4.5%, hazard ratio = 3.62, P = 0.035), while overall PVST during follow-up showed no difference (22.7% vs. 16.7%, P = 0.340). Cumulative endoscopic treatment sessions [hazard ratio = 1.98, 95% confidence interval (CI) = 1.36-2.89, P < 0.001], D-dimer (hazard ratio = 1.10, 95% CI = 1.02-1.20, P = 0.015), and white blood cell count (hazard ratio = 0.87, 95% CI = 0.77-0.98, P = 0.024) were independently associated with PVST.
CONCLUSION: EUS-CYA was associated with an increased risk of early PVST. Enhanced imaging surveillance, particularly 90-130 days after the procedure, is warranted. Cumulative endoscopic treatment sessions, D-dimer, and white blood cell count are independently associated with the development of PVST.