Giri S, Kumar K. Gastric varices management: Is clip-assisted glue injection a real-world alternative to endoscopic ultrasound-guided therapy? World J Gastroenterol 2025; 31(46): 114149 [DOI: 10.3748/wjg.v31.i46.114149]
Corresponding Author of This Article
Suprabhat Giri, Associate Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5, KIIT Rd, Patia, Bhubaneswar 751024, Odisha, India. supg19167@gmail.com
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Gastroenterology & Hepatology
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Letter to the Editor
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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/
Dec 14, 2025 (publication date) through Dec 10, 2025
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World Journal of Gastroenterology
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1007-9327
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Giri S, Kumar K. Gastric varices management: Is clip-assisted glue injection a real-world alternative to endoscopic ultrasound-guided therapy? World J Gastroenterol 2025; 31(46): 114149 [DOI: 10.3748/wjg.v31.i46.114149]
World J Gastroenterol. Dec 14, 2025; 31(46): 114149 Published online Dec 14, 2025. doi: 10.3748/wjg.v31.i46.114149
Gastric varices management: Is clip-assisted glue injection a real-world alternative to endoscopic ultrasound-guided therapy?
Suprabhat Giri, Kshitij Kumar
Suprabhat Giri, Kshitij Kumar, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Co-first authors: Suprabhat Giri and Kshitij Kumar.
Author contributions: Giri S and Kumar K contributed to the conception and design of the manuscript; Giri S and Kumar K drafted the initial manuscript; Giri S and Kumar K contributed to the critical revision of the initial manuscript; all authors contributed to the literature review, analysis, data collection, and interpretation; all the authors approved the final version of the manuscript. Giri S and Kumar K contributed equally to this work as co-first authors.
Conflict-of-interest statement: The authors declare no conflict of interest
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: Suprabhat Giri, Associate Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5, KIIT Rd, Patia, Bhubaneswar 751024, Odisha, India. supg19167@gmail.com
Received: September 15, 2025 Revised: October 19, 2025 Accepted: October 31, 2025 Published online: December 14, 2025 Processing time: 89 Days and 0.6 Hours
Abstract
Gastric variceal (GV) bleeding remains a life-threatening complication of portal hypertension, with ongoing debate regarding the optimal endoscopic therapy. Conventional endoscopic cyanoacrylate injection (ECI) is effective but limited by the risk of ectopic embolism, particularly in the presence of gastrorenal shunts. Clip-assisted ECI (clip-ECI) has emerged as a novel modification designed to reduce embolic risk while maintaining hemostatic efficacy. We appraised the recent study by Xiong et al, which compared clip-ECI with endoscopic ultrasound-guided coil and cyanoacrylate injection in 108 propensity-matched patients with cardiofundal varices and shunts. Both techniques demonstrated comparable efficacy, with obliteration rates exceeding 90% and similar one-year rebleeding rates. Importantly, no embolic events were reported. These findings are consistent with prior studies, including multicenter cohorts and a recent randomized controlled trial, which highlight clip-ECI as a safe, effective, and efficient technique, with advantages of shorter procedure times, fewer sessions, and lower costs. While endoscopic ultrasound (EUS)-guided therapy offers precision in expert hands, clip-ECI provides a practical, accessible alternative, particularly in resource-limited settings. Larger prospective studies with standardized definitions and cost-effectiveness analyses are needed to refine treatment algorithms. Clip-ECI represents a promising “flow-control assisted” strategy and a real-world alternative to EUS-based therapies for GV.
Core Tip: Clip-assisted cyanoacrylate injection (clip-ECI) is a safe, effective, and practical method for managing cardiofundal gastric varices, particularly in patients with gastrorenal shunts. Evidence from multicenter cohorts and a randomized trial shows comparable hemostasis to conventional and endoscopic ultrasound (EUS)-guided techniques, with a markedly lower risk of ectopic embolism. By restricting blood flow and improving variceal obliteration, clip-ECI reduces glue migration and often requires fewer sessions. Its shorter procedure time and lower cost make it ideal for centers with limited EUS resources.
