ArticleSurgical endoscopy2026
EUS-guided esophagogastric variceal obliteration: real-world cohort of three generation glue embolization (with video).
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
BACKGROUND AND
aimsEsophagogastric variceal bleeding (EGVB) remains life-threatening in portal hypertension. This real-world cohort documents stepwise EUS-guided glue embolization evolution for secondary prophylaxis of GOV-type EGVB, comparing sequential approaches: conventional ESVD (Endoscopic selective variceal devascularization), EUS-PCSS-D/P (EUS-guided variceal puncture with cyanoacrylate selective seal targeting the distal segment of the source vessel or perforating branch vessels), and EUS-PCSS-T (targeting the source vascular trunk). We aimed to evaluate the impact of these technical iterations on clinical outcomes.
methodsRetrospective analysis of 89 patients undergoing secondary prophylaxis: ESVD (n = 30), EUS-PCSS-D/P (n = 29), EUS-PCSS-T (n = 30). Outcomes included rebleeding rates, variceal eradication efficiency, adverse events, and survival at 1/3/6 months post-procedure.
resultsBaseline characteristics comparable (mean age 55-58 years; 50-70% male). No significant differences in EGV-related rebleeding (ESVD 23.3% vs. D/P 24.1% vs. T 13.3%), early (0-6.9%) or late rebleeding (13.3-17.2%), or all-cause GI rebleeding (13.3-33.3%). Rebleeding-free survival showed no intergroup differences overall (P = 0.221), within 180-day synchronized window (P = 0.567), or post-210-day landmark (P = 0.271). EGV eradication efficiency was superior with EUS-PCSS-T vs. ESVD or D/P (P < 0.001). Mild-moderate adverse events decreased in EUS-PCSS groups (3.5-6.7% vs. ESVD 23.3%; P = 0.033), with reduced glue use and punctures (P < 0.01).
conclusionsEUS-PCSS-T demonstrated superior variceal eradication, reduced procedural burden, and improved safety versus earlier techniques. While rebleeding/survival differences were non-significant, it represents a technically optimized approach for GOV-type EGVB secondary prophylaxis. Prospective validation warranted.
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