Combined endoscopic ultrasound and conventional endoscopy improves outcomes in bleeding GOV2 and IGV1 gastric varices: A multicenter retrospective propensity-matched cohort study.

BACKGROUND

Endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices (GVs) may leave residual untreated vessels due to incomplete visualization of distal collateral channels. Whether adding conventional endoscopic injection improves outcomes remains unclear.

OBJECTIVES

This multicenter retrospective study evaluated a combined EUS-guided and conventional endoscopic approach in patients with bleeding GOV2 or IGV1 varices.

DESIGN

This retrospective study (February 2022-December 2024) included 141 cirrhotic patients with acute gastric variceal bleeding from three Chinese tertiary centers.

METHODS

Patients received either EUS-guided therapy alone or combined therapy with supplementary conventional endoscopic injection per institutional practice. Propensity score matching (1:1) and multivariable Cox regression were used to reduce selection bias. Primary outcome was variceal rebleeding; secondary outcomes included technical success, variceal recurrence, reintervention, mortality, and adverse events.

RESULTS

Technical success was achieved in all patients (100%). After matching, variceal recurrence rates were comparable between groups (5.36% vs. 12.50%, P = 0.185), whereas rebleeding occurred less frequently in the combination group than in the EUS group (7.14% vs. 25.00%, P = 0.010). This association appeared more pronounced in IGV1 varices (2.70% vs. 27.03%, P = 0.016), although the subgroup finding should be interpreted cautiously because the interaction test was not statistically significant. Reintervention was also less frequent in the combination group (12.50% vs. 35.71%, P = 0.004). Mortality and adverse event rates were comparable between groups.

CONCLUSION

Supplementary conventional endoscopic injection after EUS-guided therapy was associated with lower risks of rebleeding and reintervention without an apparent increase in adverse events. This combineds strategy may be a feasible option to improve treatment durability in selected patients with high-risk GOV2 or IGV1 gastric varices, but prospective randomized studies are needed for confirmation.