Affiliation:
1. Department of Gastroenterology The First Affiliated Hospital of Anhui Medical University Hefei China
2. Department of Gastroenterology First People's Hospital of Hefei Hefei China
Abstract
ObjectivesAlthough the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.MethodsIn a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.ResultsA total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (n = 76) and TIPS group (n = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (P = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (P = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (P = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (P = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (P = 0.001).ConclusionBoth groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.
Funder
National Natural Science Foundation of China
Reference37 articles.
1. Current approaches to the treatment of gastric varices: Glue, coil application, TIPS, and BRTO;Goral V;Medicina (Kaunas),2019
2. EUS‐guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: A large U.S. experience over 6 years (with video);Bhat YM;Gastrointest Endosc,2016
3. Beyond the scope and the glue: Update on evaluation and management of gastric varices;Philips CA;BMC Gastroenterol,2020
4. Thromboembolic events secondary to endoscopic cyanoacrylate injection: Can we foresee any red flags?;Tseng Y;Can J Gastroenterol Hepatol,2018
5. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 Practice guidance by the American Association for the Study of Liver Diseases;Garcia‐Tsao G;Hepatology,2017