Gastrointestinal endoscopy · 2026
Bicentric comparison of 3-year clinical outcomes between endoscopic ultrasound-guided embolization with coil and hemostatic adjunct versus balloon-occluded retrograde transvenous obliteration for treatment of bleeding gastric varices: A propensity-score matched study.
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Siranart Noppachai, Wang Thomas J, Konyn Peter, Bazarbashi Ahmad N, Jirapinyo Pichamol, Thompson Christopher C, Zucker Stephen D, Ryou Marvin
Аннотация
BACKGROUND AND AIMS: Endoscopic ultrasound-guided coil injection (EUS-COIL) and balloon-occluded retrograde transvenous obliteration (BRTO) performed by interventional radiology (IR) are both effective obliterative procedures to treat gastric varices. Comparative studies are lacking. Our aim was to assess clinical outcomes for EUS-COIL versus BRTO for treatment of acute gastric variceal bleeding.
METHODS: This retrospective cohort study included all patients admitted to two tertiary care centers between 2009-2024 who underwent either EUS-COIL or BRTO for bleeding gastric varices. The primary outcomes were technical/clinical success and adverse events. Secondary outcomes included transfusions, reintervention, length of hospital stay, further hepatic decompensation (esophageal variceal hemorrhage, new ascites, or new hepatic encephalopathy (HE)), and all-cause mortality. Subgroup analyses were performed in patients with cirrhosis, including with propensity score matching (PSM) which was conducted 1:1 for age, sex, Child-Pugh classification, MELD-Na score, and hemoglobin level on admission. Outcomes over the 36-months post-intervention were assessed using time-to-event analysis.
RESULTS: A total of 94 patients were included (48 EUS-COIL, 46 BRTO), of whom 60 patients with cirrhosis (30 per group) were analyzed after propensity score matching. In the matched cohort, technical success was 100% in both groups and clinical success was 100% versus 93.3% (p=0.49). The EUS-COIL group experienced significantly fewer adverse events (3% vs 37%; p=0.003) and had a longer time-to-reintervention (65 ± 52 days vs 10 ± 9.6 days; p=0.022) over a median follow-up 900 ± 790 days. The incidence of further hepatic decompensation was lower in the EUS-COIL group (10% vs 40%; p=0.007), as was the likelihood of further hepatic decompensation (HR 0.28 (95%CI: 0.08-0.984), p = 0.047) compared to BRTO. No significant differences were observed with regard to post-procedural transfusion requirements, rates of reintervention, length of hospital stay, and mortality in cirrhosis patients. In the unmatched cohort, technical (100% vs 80%; p=0.001) and clinical (100% vs 89%; p=0.03) success were higher with EUS-COIL than BRTO.
CONCLUSIONS: In patients with gastric variceal hemorrhage, EUS-COIL demonstrated higher rates of technical/clinical success and lower rates of adverse events (both peri-procedural and on long-term follow-up) compared to BRTO. EUS-COIL had significantly lower rates of further hepatic decompensation. While larger prospective studies are required, these data suggest that EUS-COIL, when available, may be the preferred initial therapy for bleeding gastric varices as part of a step-up strategy.
METHODS: This retrospective cohort study included all patients admitted to two tertiary care centers between 2009-2024 who underwent either EUS-COIL or BRTO for bleeding gastric varices. The primary outcomes were technical/clinical success and adverse events. Secondary outcomes included transfusions, reintervention, length of hospital stay, further hepatic decompensation (esophageal variceal hemorrhage, new ascites, or new hepatic encephalopathy (HE)), and all-cause mortality. Subgroup analyses were performed in patients with cirrhosis, including with propensity score matching (PSM) which was conducted 1:1 for age, sex, Child-Pugh classification, MELD-Na score, and hemoglobin level on admission. Outcomes over the 36-months post-intervention were assessed using time-to-event analysis.
RESULTS: A total of 94 patients were included (48 EUS-COIL, 46 BRTO), of whom 60 patients with cirrhosis (30 per group) were analyzed after propensity score matching. In the matched cohort, technical success was 100% in both groups and clinical success was 100% versus 93.3% (p=0.49). The EUS-COIL group experienced significantly fewer adverse events (3% vs 37%; p=0.003) and had a longer time-to-reintervention (65 ± 52 days vs 10 ± 9.6 days; p=0.022) over a median follow-up 900 ± 790 days. The incidence of further hepatic decompensation was lower in the EUS-COIL group (10% vs 40%; p=0.007), as was the likelihood of further hepatic decompensation (HR 0.28 (95%CI: 0.08-0.984), p = 0.047) compared to BRTO. No significant differences were observed with regard to post-procedural transfusion requirements, rates of reintervention, length of hospital stay, and mortality in cirrhosis patients. In the unmatched cohort, technical (100% vs 80%; p=0.001) and clinical (100% vs 89%; p=0.03) success were higher with EUS-COIL than BRTO.
CONCLUSIONS: In patients with gastric variceal hemorrhage, EUS-COIL demonstrated higher rates of technical/clinical success and lower rates of adverse events (both peri-procedural and on long-term follow-up) compared to BRTO. EUS-COIL had significantly lower rates of further hepatic decompensation. While larger prospective studies are required, these data suggest that EUS-COIL, when available, may be the preferred initial therapy for bleeding gastric varices as part of a step-up strategy.