ArticleSurgical endoscopy2026
EUS-guided coil-free cyanoacrylate injection for the management of isolated gastric varices type 1 with gastrorenal shunts: The first case series.
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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Abstract
backgroundBleeding from isolated gastric varices type 1 (IGV-1) with gastrorenal shunts (GRS) carries a high risk. Although EUS-guided coil-assisted cyanoacrylate (CYA) injection is effective, coil use raises concerns regarding long-term safety and cost. This study was performed to evaluate the feasibility, efficacy, and safety of EUS-guided coil-free direct CYA injection for managing IGV-1 with GRS.
methodsThis single-center, retrospective case series included 15 consecutive patients with IGV-1 and GRS who underwent EUS-guided coil-free direct CYA injection between November 2024 and May 2025. Under real-time EUS/Doppler guidance, the primary feeding vessel was punctured, and a modified "sandwich" technique was employed; conventional gastroscopic direct CYA injection (CGD-CYA injection) was performed for residual varices in selected patients. The primary outcomes were technical success, variceal obliteration at 6 months, and 6-week rebleeding rates.
resultsThe technical success rate was 100% (15/15). Fourteen patients (93.33%) achieved complete variceal obliteration on follow-up imaging (median 210 days). The early rebleeding rate (within 6 weeks) was 13.33%, with no late rebleeding occurring thereafter. The rebleeding-free survival rate was 80.00% during follow-up. The median EUS-guided CYA injection volume was 4.00 mL. No major adverse events, including symptomatic ectopic embolism, were observed. Minor adverse events-transient fever (33.33%) and abdominal pain (40.00%)-were self-limiting.
conclusionEUS-guided coil-free direct CYA injection appears to be a feasible and safe alternative for managing IGV-1 with GRS, demonstrating high technical success and effective obliteration. CGD-CYA injection serves as a valuable supplementary treatment for residual varices, further improving obliteration efficacy. Despite an observed early rebleeding rate, the technique may potentially offer a valuable option, particularly in resource-limited settings.
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