Evidence map›Paper›PMID 42387146›Full record

SynthesisDigestive diseases and sciences2026

The Efficacy and Safety of Clip-Assisted Endoscopic Cyanoacrylate Injection for Gastric Varices: A Systematic Review and Meta-Analysis.

Mohamed Abuelazm, Yousef Hawas, Belal Mohamed Hamed, Abdelrahman Awad, EzzElDien A Ibrahim, Hatem Eltaly, Mohamed Nasser Elshabrawi, Ibrahim Gowaily, Mohamed Elgendy, Douglas G Adler

Erratum issuedAbstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Mohamed AbuelazmFaculty of Medicine, Tanta University, Tanta, Egypt.
Yousef HawasFaculty of Medicine, Tanta University, Tanta, Egypt.
Belal Mohamed HamedFaculty of Medicine, Al-Azhar Cairo University, Cairo, Egypt.
Abdelrahman AwadFaculty of Medicine, Mansoura University, Mansoura, Egypt.
EzzElDien A IbrahimDepartment of Medicine, University of Missouri, Columbia, MO, USA.
Hatem EltalyCleveland Clinic Main Campus, Cleveland, USA.
Mohamed Nasser ElshabrawiClinical Research Department, Aswan Heart Center, Magdi Yaqoup Foundation, Aswan, Egypt.
Ibrahim GowailyDepartment of Internal Medicine, Creighton University, Omaha, NE, USA.
Mohamed ElgendyFaculty of Medicine, Tanta University, Tanta, Egypt.
Douglas G AdlerCenter for Advanced Therapeutic Endoscopy, Advent Health, Denver, CO, 80210, USA. dougraham2001@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBleeding from gastric varices (GVs) is a severe complication of portal hypertension. Conventional endoscopic cyanoacrylate injection (Con-ECI) is an effective treatment, but it is associated with significant risks of rebleeding and systemic ectopic embolism. Clip-assisted ECI (Clip-ECI), where clips are deployed before glue injection, has been developed to mitigate these risks, but its efficacy remains debatable.

methodsA comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted for studies up to August 2025. The primary outcomes were all-cause rebleeding and ectopic embolism. Secondary outcomes included variceal obliteration, mortality, and procedure-related complications. Risk ratios (RR) with 95% confidence intervals (CI) were pooled from randomized and non-randomized studies using a random-effects model. PROSPERO ID: CRD420251163015.

resultsSeven studies involving 783 patients were included. Compared to Con-ECI, Clip-ECI was associated with a significantly lower risk of variceal rebleeding (RR: 0.24; 95% CI [0.12, 0.48]; P < 0.001) and ectopic embolism (RR: 0.31; 95% CI [0.13, 0.76]; P = 0.01). The pooled rates of variceal rebleeding and ectopic embolism in the Clip-ECI group were 7.1% and 2.1%, respectively. Also, Clip-ECI achieved a significantly higher rate of complete variceal obliteration (RR: 1.39; 95% CI [1.23, 1.57]; P < 0.001). There were no significant differences in all-cause mortality (P = 0.28), technical success (P = 0.35), or other adverse events.

conclusionIn patients with GVs, Clip-ECI significantly reduces the risks of rebleeding and ectopic embolism while improving variceal obliteration, without increasing adverse events, compared with Con-ECI.

Indexed as

CyanoacrylatesEsophageal and Gastric VaricesGastrointestinal HemorrhageHemostasis, EndoscopicSurgical InstrumentsHumansInjectionsTreatment OutcomeCyanoacrylatesClinical trialEndoscopyGastroenterologyGastrointestinal bleedingHemostasis

Identifiers

PMID42387146

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.