Xiong YY, Li DW, Zhou TY, Ma H, Gao JG, Shen Z, Xu CF, Yu CH. Clip-assisted endoscopic cyanoacrylate injection vs endoscopic ultrasound-guided coil and cyanoacrylate injection for gastric varices: A propensity score-matched study. World J Gastroenterol 2025; 31(38): 111363 [DOI: 10.3748/wjg.v31.i38.111363]
Corresponding Author of This Article
Chao-Hui Yu, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zyyyych@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 14, 2025; 31(38): 111363 Published online Oct 14, 2025. doi: 10.3748/wjg.v31.i38.111363
Clip-assisted endoscopic cyanoacrylate injection vs endoscopic ultrasound-guided coil and cyanoacrylate injection for gastric varices: A propensity score-matched study
Yang-Yang Xiong, Di-Wu Li, Tian-Yu Zhou, Han Ma, Jian-Guo Gao, Zhe Shen, Cheng-Fu Xu, Chao-Hui Yu, Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xiong YY, Shen Z, Xu CF and Yu CH designed the trial; Xiong YY, Li DW and Zhou TY collected the data; Ma H and Gao JG analyzed the data; Xiong YY drafted the manuscript; Xu CF and Yu CH supervised the entire process.
Supported by the National Natural Science Foundation of China, No. 82200664; and the Clinical Research Program of The First Affiliated Hospital, Zhejiang University School of Medicine, No. BL2025023.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No. 2024IIT803).
Informed consent statement: This study was a retrospective cohort analysis. The information and data involved posed no risk to the patients. In accordance with the requirements of the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, the need for informed consent was waived. Please refer to the ethics approval document for details.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The original data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao-Hui Yu, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zyyyych@zju.edu.cn
Received: June 30, 2025 Revised: July 30, 2025 Accepted: September 1, 2025 Published online: October 14, 2025 Processing time: 108 Days and 17 Hours
Abstract
BACKGROUND
The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage. Clip-assisted endoscopic cyanoacrylate injection (Clip-CYA) and endoscopic ultrasound-guided coil and cyanoacrylate injection (EUS-CG) are two currently used modalities. There are limited data comparing the two techniques.
AIM
To compare the efficacy, safety, and procedural characteristics of Clip-CYA vs EUS-CG for treatment of gastric varices (GVs) with spontaneous portosystemic shunts.
METHODS
Between April 2019 and August 2023, 162 patients with GVs and concomitant gastrorenal or splenorenal shunts who underwent either Clip-CYA or EUS-CG at our center were included. After 1:2 propensity score matching, 108 patients were included in the final analysis. The evaluated outcomes included the amount of cyanoacrylate, eradication of GVs, cyanoacrylate embolization, all-cause rebleeding, operating time and endoscopic therapy costs.
RESULTS
Of the 108 patients, 72 (male, 83.3%; mean age, 56.2 ± 10.8 years) received Clip-CYA, and 36 (male, 72.2%; mean age, 59.1 ± 10.7 years) received EUS-CG. The amount of cyanoacrylate used, rates of obliteration of GVs and all-cause rebleeding were similar between the two groups (2.0 ± 1.1 mL vs 2.0 ± 0.6 mL, P = 0.913; 91.7% vs 94.4%, P = 0.603; and 23.6% vs 19.4%, P = 0.623, respectively). No cyanoacrylate embolization occurred in either group. Compared with EUS-CG, Clip-CYA was associated with significantly shorter operating times (24.0 ± 9.9 minutes vs 47.1 ± 21.0 minutes, P < 0.001) and lower endoscopic therapy costs (7523.4 ± 5719.4 Chinese yuan vs 11153.7 ± 7679.1 Chinese yuan, P = 0.007). These advantages persisted in the subgroup analysis of patients whose GVs had a maximum diameter > 3 cm or > 4 cm.
CONCLUSION
Compared with EUS-CG, Clip-CYA of GVs appears to be a safe procedure with shorter operating times and lower endoscopic therapy costs.
Core Tip: This propensity score-matched study compared clip-assisted endoscopic cyanoacrylate injection (Clip-CYA) and endoscopic ultrasound-guided coil and cyanoacrylate injection (EUS-CG) for gastric varices (GVs) with spontaneous portosystemic shunts. Both methods achieved comparable efficacy and safety. However, Clip-CYA required significantly less procedure time and cost, even in patients with large varices (> 3 cm). These findings suggest that Clip-CYA may serve as a more efficient and accessible alternative to EUS-CG in the emergency and real-world treatment of bleeding GVs.
