Abstract
BACKGROUND: The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage. Clip-assisted endoscopic cyanoacrylate injection (Clip-CYA) and endoscopic ultrasound-guided coil and cyanoacrylate injection (EUS-CG) are two currently used modalities. There are limited data comparing the two techniques. AIM: To compare the efficacy, safety, and procedural characteristics of Clip-CYA vs EUS-CG for treatment of gastric varices (GVs) with spontaneous portosystemic shunts. METHODS: Between April 2019 and August 2023, 162 patients with GVs and concomitant gastrorenal or splenorenal shunts who underwent either Clip-CYA or EUS-CG at our center were included. After 1:2 propensity score matching, 108 patients were included in the final analysis. The evaluated outcomes included the amount of cyanoacrylate, eradication of GVs, cyanoacrylate embolization, all-cause rebleeding, operating time and endoscopic therapy costs. RESULTS: Of the 108 patients, 72 (male, 83.3%; mean age, 56.2 ± 10.8 years) received Clip-CYA, and 36 (male, 72.2%; mean age, 59.1 ± 10.7 years) received EUS-CG. The amount of cyanoacrylate used, rates of obliteration of GVs and all-cause rebleeding were similar between the two groups (2.0 ± 1.1 mL vs 2.0 ± 0.6 mL, P = 0.913; 91.7% vs 94.4%, P = 0.603; and 23.6% vs 19.4%, P = 0.623, respectively). No cyanoacrylate embolization occurred in either group. Compared with EUS-CG, Clip-CYA was associated with significantly shorter operating times (24.0 ± 9.9 minutes vs 47.1 ± 21.0 minutes, P < 0.001) and lower endoscopic therapy costs (7523.4 ± 5719.4 Chinese yuan vs 11153.7 ± 7679.1 Chinese yuan, P = 0.007). These advantages persisted in the subgroup analysis of patients whose GVs had a maximum diameter > 3 cm or > 4 cm. CONCLUSION: Compared with EUS-CG, Clip-CYA of GVs appears to be a safe procedure with shorter operating times and lower endoscopic therapy costs.