Endoscopic ultrasound-guided coil and glue embolization is superior to endoscopic cyanoacrylate glue injection for gastric varices: a propensity-matched analysis from India.

backgroundEndoscopic cyanoacrylate glue injection (END-G) is the recommended therapy for gastric varices; however, endoscopic ultrasound-guided coil and glue embolization (EUS-C+G) is increasingly utilized. This study compared the efficacy and safety of END-G and EUS-C+G.

methodsWe retrospectively analyzed patients with gastric varices who underwent variceal obliteration. Propensity score matching (1:1) was used to balance baseline variables. The primary outcome was variceal obliteration at 4 weeks, and the secondary outcomes included adverse events (AEs), bleeding, ascites, and mortality. Predictors of incomplete obliteration were assessed using END-G.

resultsA total of 442 patients were included. In the matched cohort (n=71/group), EUS-C+G achieved higher obliteration rates than those of END-G (95.8% vs. 64.8%, p<0.001) with a low glue volume (median 1.5 mL vs. 2.5 mL, p<0.001). AEs were more frequent with EUS-C+G (25.4% vs. 8.5%, p=0.007), although they were generally mild and managed conservatively. The rates of bleeding, ascites, and 4-week mortality were similar between groups. Subgroup analysis showed the superiority of EUS-C+G in patients with isolated fundal varices (93.1% vs. 50.0%) and in secondary prophylaxis (95.0% vs. 53.3%), although with high AEs. Portal vein thrombosis (odds ratio, 154.086) and a varix size ≥18 mm (odds ratio, 2.664) predicted incomplete obliteration with END-G.

conclusionsEUS-C+G provides superior short-term obliteration compared with END-G, although with increased but milder AEs. Careful patient selection and expertise are essential.