Gastrointestinal endoscopy · 2026
Efficacy and safety of endoscopic ultrasound-guided coil embolization with gelatin sponge versus coil embolization with glue for gastric varices.
СтатьяНазвание и аннотация: Перевод в очереди
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Jhajharia Ashok, Gupta Namit, Sarin Manasvin, Singh Shashank, Ashdhir Prachis, Pokharna Rupesh Kumar, Verma Manoj
Аннотация
BACKGROUND AND AIMS: Gastric varices (GV) are less common than esophageal varices but have a higher propensity for severe bleeding. Management of GV is challenging and requires effective endoscopic strategies. This study aimed to compare EUS-guided coil embolization with absorbable gelatin sponge (group A) versus EUS-guided coil embolization with glue therapy (group B) for the treatment of GV.
METHODS: This was a prospective randomized clinical trial conducted at a single tertiary care center. Seventy patients were randomly allocated in a 1:1 ratio, with 35 patients in each group. EUS-guided coil insertion was performed in both groups, followed by injection of absorbable gelatin sponge slurry and cyanoacrylate glue in groups A and B, respectively. Technical success, clinical success, reappearance of GV, need for reintervention, and adverse events were assessed.
RESULTS: The majority of patients had large GV (>10 mm), predominantly gastroesophageal varices type 2. A 100% technical success rate was achieved in both groups, and the clinical success rate was similar (94.2% vs 91.4%; P = 1.00). The need for reintervention was significantly lower in group A than in group B (17.1% vs 42.9%; P = .035). Variceal reappearance was observed in 5.7% of patients in group A compared with 14.3% in group B, and recurrent bleeding occurred in 5.7% of patients in group A versus 20% in group B. The cumulative incidence of recurrent bleeding was significantly lower in group A (P = .04).
CONCLUSIONS: EUS-guided coil embolization with absorbable gelatin sponge required fewer reinterventions for the management of GV. Management with absorbable gelatin sponge demonstrates a safety profile comparable with glue therapy and a favorable cumulative recurrent bleeding profile during follow-up.
METHODS: This was a prospective randomized clinical trial conducted at a single tertiary care center. Seventy patients were randomly allocated in a 1:1 ratio, with 35 patients in each group. EUS-guided coil insertion was performed in both groups, followed by injection of absorbable gelatin sponge slurry and cyanoacrylate glue in groups A and B, respectively. Technical success, clinical success, reappearance of GV, need for reintervention, and adverse events were assessed.
RESULTS: The majority of patients had large GV (>10 mm), predominantly gastroesophageal varices type 2. A 100% technical success rate was achieved in both groups, and the clinical success rate was similar (94.2% vs 91.4%; P = 1.00). The need for reintervention was significantly lower in group A than in group B (17.1% vs 42.9%; P = .035). Variceal reappearance was observed in 5.7% of patients in group A compared with 14.3% in group B, and recurrent bleeding occurred in 5.7% of patients in group A versus 20% in group B. The cumulative incidence of recurrent bleeding was significantly lower in group A (P = .04).
CONCLUSIONS: EUS-guided coil embolization with absorbable gelatin sponge required fewer reinterventions for the management of GV. Management with absorbable gelatin sponge demonstrates a safety profile comparable with glue therapy and a favorable cumulative recurrent bleeding profile during follow-up.