EUS-Guided Cyanoacrylate Injection With Balloon-Compression Sclerotherapy Versus Band Ligation for Gastroesophageal Varices: A Randomized Trial.
Xu Yang, Zhihong Wang, Yuxin Liao et al.
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In 30 seconds
This single-center randomized controlled trial compared two endoscopic strategies in cirrhotic patients with gastroesophageal varices: EUS-guided cyanoacrylate injection for gastric varices combined with balloon-compression injection sclerotherapy (bc-EIS) or endoscopic variceal ligation (EVL) for esophageal varices. At 6 months, gastric varices were eradicated in both groups, while esophageal variceal eradication was 100% with bc-EIS versus 82.3% with EVL (p < 0.001). The bc-EIS group also required fewer treatment sessions. Rebleeding was numerically lower with bc-EIS, but the difference was not statistically significant.
Key findings
- Esophageal variceal eradication was 100% with bc-EIS versus 82.3% with EVL (p < 0.001).
- Treatment sessions averaged 1.4 ± 0.6 with bc-EIS versus 2.1 ± 1.1 with EVL (p < 0.001).
- Rebleeding occurred in 9.7% versus 21.0%, respectively (p = 0.081); hemostasis was 100% in both groups.
- Complications occurred in 14.5% with bc-EIS and 17.7% with EVL; no severe adverse events were reported.
Why it matters
The trial addresses how to manage concomitant esophageal varices when EUS-guided cyanoacrylate is used for gastric varices. Greater esophageal variceal eradication and fewer treatment sessions with bc-EIS may be relevant to treatment planning, while the similar reported safety outcomes and non-significant rebleeding difference help frame the limits of the observed advantage.
What to keep in mind
The trial was conducted at a single center, and the abstract reports follow-up for the primary endpoint at 6 months.