TOPLINE:

In patients with isolated gastric varices type 1 (IGV1) with spontaneous shunts, endoscopic ultrasonography (EUS)-guided cyanoacrylate injections were very effective at treating bleeding — achieving lower rates of rebleeding and higher rates of complete occlusion than direct endoscopic injections. Cumulative nonbleeding rates were higher in the EUS-guided cyanoacrylate injection group.

METHODOLOGY:

• EUS-guided cyanoacrylate injection offers a precise approach, potentially reducing the risk for complications by accurately identifying varices and their feeding vessels.
• Researchers conducted a prospective randomized controlled trial to compare the efficacy of the EUS-guided and direct injection techniques; they included 96 adult patients admitted for IGV1 bleeding due to cirrhosis with spontaneous portosystemic shunts confirmed via abdominal CT angiography.
• Participants were randomly assigned to two groups: 47 received EUS-guided cyanoacrylate injections, with EUS used for identification of gastric varices, and 49 received direct endoscopic injections, with gastroscopy performed under anesthesia to inspect gastric mucosa and varices.
• In both methods, a modified sandwich technique was applied with lauromacrogol-cyanoacrylate injections, and the dosage was adjusted on the basis of varix size. Treatments were repeated every 2 weeks until the eradication of gastric varices was confirmed.
• The primary outcome measured was the rebleeding rate — both early (5 days to 6 weeks) and late (more than 6 weeks) postoperative rebleeding. The outcomes were assessed over a mean follow-up duration of 24.17 vs 24.69 months for the EUS-guided cyanoacrylate group vs the direct endoscopic injection group.

TAKEAWAY:

• Over the follow-up, the rebleeding rate was lower in the EUS-guided group than in the direct endoscopic injection group (19.15% vs 42.86%; P = .012). Both groups achieved 100% technical success rates.
• The cyanoacrylate volume used was lower in the EUS-guided group vs the direct injection group (1.63 ± 1.08 mL vs 2.59 ± 1.66 mL; P = .001). The cumulative nonbleeding rates at 6, 12, 18, and 24 months were higher in the EUS-guided group than in the direct endoscopic injection group (P = .042).
• Complete occlusion of gastric varices was achieved in 85.71% of patients in the EUS-guided group compared with 67.35% of those in the direct injection group (P = .009), with similar mortality rates between the two groups (12.77% and 16.33%, respectively).
• No cases of ectopic embolism occurred in the EUS-guided group, whereas one case of pulmonary embolism was reported in the direct endoscopic injection group. Complication rates did not differ significantly between the groups.

IN PRACTICE:

“EUS-CYA [EUS-guided cyanoacrylate] allowed for precise identification of GV [gastric varices] and feeding veins, leading to better control of glue application, reducing glue leakage, and ensuring more reliable embolization, thus lowering the long-term rebleeding risk,” the authors of the study wrote.

SOURCE:

The study was led by Jing Li, Department of Gastroenterology, Third People’s Hospital of Bengbu, Bengbu, China. It was published online in Therapeutic Advances in Gastroenterology.

LIMITATIONS:

The single-center design may limit generalizability, and the small sample size could affect the stability of the results. The procedures were performed by experienced endoscopists, potentially limiting applicability to practitioners with varying expertise. The lack of nonselective beta-blockers in the treatment protocol may limit the applicability of the findings to broader clinical practice.

DISCLOSURES:

The study was supported by the National Natural Science Foundation of China. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.