Gastrointestinal endoscopy · 2026
Endoscopic ultrasound-guided coil and glue embolization of gastric varices targeting feeder vessel versus submucosal variceal component: a pragmatic comparative analysis (with videos).
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Dhar Jahnvi, Thakur Rahul, Gupta Pankaj, Tandup Cherring, Nagaraj Satish Subbiah, Sinha Saroj Kant, Crinò Stefano Francesco, Ryou Marvin, Samanta Jayanta
Аннотация
BACKGROUND AND AIMS: EUS-guided coil and glue of gastric varices (GV), targeting the submucosal variceal component (SVC), has always been the conventional strategy. In cases in which the feeder vessel can be delineated, targeting the feeder alone (EUS-F) instead of the SVC seems logical and has never been systematically compared.
METHODS: This study included patients with GV with a discernible feeder vessel localized on EUS and characterized as per the Sarin and Arakawa classification. Patients were divided into 2 arms, in which either the feeder or the SVC was targeted and obliterated. The primary outcome (reintervention rates) and secondary outcomes (amount of glue, number of coils, obliteration, and bleeding rates) at 6 months were analyzed.
RESULTS: A total of 135 patients (EUS-F, 32; EUS-SVC, 103) were evaluated. Gastroesophageal varices type 2 (81; 60%) and type 1 Arakawa (97; 71.85%) were the most common GV types. The strategy of EUS-F showed lower requirements of both coil (P = .0001) and glue (P = .0001), not only at the index procedure but also overall requirement of coils (1.94 ± 0.91 vs 2.79 ± 1.76; P = .001) and glue (1.88 ± 0.64 vs 2.83 ± 1.70 mL; P < .0001) at 6 months. Overall reintervention rates at 6 months were significantly lower in the EUS-F arm (3.1% vs 17.5%; P = .04), along with the number of EUS sessions needed for complete GV obliteration (P = .02).
CONCLUSIONS: For EUS-guided angioembolization of GV, targeting the feeder vessel, when feasible and discernible, over SVC (conventional method) results in significantly lower requirements of coil and glue, with significantly lower reintervention rates, which might translate to a more cost-effective strategy.
METHODS: This study included patients with GV with a discernible feeder vessel localized on EUS and characterized as per the Sarin and Arakawa classification. Patients were divided into 2 arms, in which either the feeder or the SVC was targeted and obliterated. The primary outcome (reintervention rates) and secondary outcomes (amount of glue, number of coils, obliteration, and bleeding rates) at 6 months were analyzed.
RESULTS: A total of 135 patients (EUS-F, 32; EUS-SVC, 103) were evaluated. Gastroesophageal varices type 2 (81; 60%) and type 1 Arakawa (97; 71.85%) were the most common GV types. The strategy of EUS-F showed lower requirements of both coil (P = .0001) and glue (P = .0001), not only at the index procedure but also overall requirement of coils (1.94 ± 0.91 vs 2.79 ± 1.76; P = .001) and glue (1.88 ± 0.64 vs 2.83 ± 1.70 mL; P < .0001) at 6 months. Overall reintervention rates at 6 months were significantly lower in the EUS-F arm (3.1% vs 17.5%; P = .04), along with the number of EUS sessions needed for complete GV obliteration (P = .02).
CONCLUSIONS: For EUS-guided angioembolization of GV, targeting the feeder vessel, when feasible and discernible, over SVC (conventional method) results in significantly lower requirements of coil and glue, with significantly lower reintervention rates, which might translate to a more cost-effective strategy.