CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(02): E202-E210
DOI: 10.1055/a-1984-7070
Original article

EUS-guided cyanoacrylate injection into the perforating vein versus direct endoscopic injection in the treatment of gastric varices

Fady Sabry
1   Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt
,
Seham Seif
1   Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt
,
Ayman Eldesoky
1   Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt
,
Hazem Hakim
1   Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt
,
Ahmed Youssef Altonbary
1   Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt
› Author Affiliations
TRIAL REGISTRATION: prospective randomized controlled study NCT04222127 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)

Abstract

Background and study aims Endoscopic injection of gastric varices (GVs) using cyanoacrylate (CYA) is associated with significant adverse events (AEs). We aimed to compare the efficacy and safety of endoscopic ultrasound (EUS)-guided CYA injection into the perforating vein versus direct endoscopic injection (DEI) of CYA in treatment of high-risk GVs.

Patients and methods This was a randomized controlled trial that included 52 patients with high-risk GVs. Group A underwent EUS-guided injection into the perforator vein and Group B underwent DEI of 1 mL CYA. Endoscopic examination and Doppler EUS were repeated after 3 months to confirm eradication. Obliteration by Doppler EUS was considered by absence of Doppler flow within the varix. Repeated injection was performed in the absence of obliteration. Doppler EUS examination was repeated at 3 and 6 months after each injection.

Results Forty-three patients including 27 males and 16 females with mean age 57 years completed the study. Variceal obliteration was achieved during the index session after 3 months in eight of 21 (38.1 %) in group B compared to 17 of 22 (77.2 %) in group A (P = 0.014). There was a significant difference in the amount of CYA needed to achieve obliteration in group B compared to group A (2 vs.1 mL, P = 0.027). There was no statistically significant difference in the overall AE rate between group A and group B (4.5 % vs. 14.3 %, P = 0.345).

Conclusions EUS-guided CYA injection into the perforating veins achieved less amount of CYA, fewer number of sessions to obliteration, and similar overall AE rates in the treatment of high-risk GVs compared to DEI.



Publication History

Received: 30 September 2022

Accepted after revision: 18 November 2022

Accepted Manuscript online:
22 November 2022

Article published online:
23 February 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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