Clip-assisted endoscopic cyanoacrylate injection vs endoscopic ultrasound-guided coil and cyanoacrylate injection for gastric varices: A propensity score-matched study

doi:10.3748/wjg.v31.i38.111363

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Oct 14, 2025 (publication date) through Oct 14, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Oct 14, 2025; 31(38): 111363
Published online Oct 14, 2025. doi: 10.3748/wjg.v31.i38.111363

Table 1 Baseline comparison between the clip and endoscopic ultrasound groups, mean ± SD/n (%)

Variable	Before propensity score matching			After propensity score matching
Variable	Clip group (n = 103)	EUS group (n = 59)	P value	Clip group (n = 72)	EUS group (n = 36)	P value
Sex			0.326			0.177
Male	83 (80.6)	43 (72.9)		60 (83.3)	26 (72.2)
Female	20 (19.4)	16 (27.1)		12 (16.7)	10 (27.8)
Age, year	56.4 ± 11.2	57.6 ± 10.0	0.494	56.2 ± 10.8	59.1 ± 10.7	0.186
Etiology of cirrhosis			0.968			0.695
Viral hepatitis B	68 (66.0)	39 (66.1)		47 (65.3)	20 (55.6)
Viral hepatitis C	2 (1.9)	1 (1.7)		1 (1.4)	1 (2.8)
Alcohol consumption	8 (7.8)	5 (8.5)		6 (8.3)	5 (13.9)
Autoimmune	10 (9.7)	3 (5.1)		7 (9.7)	3 (8.3)
Parasite	3 (2.9)	5 (8.5)		2 (2.8)	3 (8.3)
Cryptogenic	12 (11.7)	6 (10.2)		9 (12.5)	4 (11.1)
Concomitant HCC	19 (18.4)	15 (25.4)	0.320	16 (22.2)	8 (22.2)	1.000
Child-Pugh grade			0.104			0.202
A	38 (36.9)	30 (50.8)		26 (36.1)	19 (52.8)
B	58 (56.3)	23 (39.0)		41 (56.9)	14 (38.9)
C	7 (6.8)	6 (10.2)		5 (6.9)	3 (8.3)
Presentation active bleed	73 (70.9)	38 (64.4)	0.551	52 (72.2)	24 (66.7)	0.551
Previous GV bleeding	61 (59.2)	45 (76.3)	< 0.001	41 (56.9)	25 (69.4)	0.209
RCS on GV	67 (66.3)	36 (61.0)	0.500	47 (66.2)	22 (61.1)	0.603
Concomitant esophageal varices	88 (85.4)	51 (86.4)	0.996	60 (83.3)	29 (80.6)	0.530
Type of gastric varix			0.143			0.134
GOV2	52 (50.5)	37 (62.7)		33 (45.8)	22 (61.1)
IGV1	51 (49.5)	22 (37.3)		39 (54.2)	14 (38.9)
Maximum diameter of gastric fundal varices, cm	2.4 ± 1.3	2.5 ± 1.2	0.481	2.5 ± 1.1	2.5 ± 1.3	0.609
Type of spontaneous portosystemic shunts			0.082			0.319
Gastrorenal shunt	43 (41.7)	33 (55.9)		23 (31.9)	15 (41.7)
Splenorenal shunt	60 (58.3)	26 (44.1)		49 (68.1)	21 (58.3)
Minimum diameter of shunt varices, cm	0.5 ± 0.2	0.4 ± 0.2	0.354	0.5 ± 0.2	0.4 ± 0.2	0.326
Child-Pugh score	7.3 (1.6)	6.9 (1.8)	0.092	7.1 (1.3)	6.8 (1.8)	0.355
MELD score	9.6 (3.3)	8.6 (3.4)	0.091	8.9 (2.3)	8.2 (4.1)	0.213
Length of stay, day, median (IQR)	7 (2-28)	7 (3-23)	0.196	7 (2-27)	7.5 (3-23)	0.889
Follow-up time, month, median (IQR)	29.4 (9.8-53.0)	30.3 (9.8-53.3)	0.041	29.5 (9.8-53.0)	31.1 (9.8-75.3)	0.093

EUS: Endoscopic ultrasound; HCC: Hepatocellular carcinoma; RCS: Red color sign; GVs: Gastric varices; GOV2: Gastroesophageal varices type 2; IGV1: Isolated gastric varices type 1; IQR: Interquartile range; MELD: Model for end-stage liver disease.

Full Size Table

Table 2 Clinical outcome comparison between clip-assisted endoscopic cyanoacrylate injection and endoscopic ultrasound-guided coil and cyanoacrylate injection management of gastric varices, mean ± SD/n (%)

Variable	Clip group (n = 72)	EUS group (n = 36)	P value
Technique success	72 (100)	36 (100)
Clip number, median (IQR)	2 (1-5)
Coil number, median (IQR)		2 (1-3)
Amount of cyanoacrylate, mL	2.0 ± 1.1	2.0 ± 0.6	0.913
Eradication of gastric fundal varices	66 (91.7)	34 (94.4)	0.603
Operating time, minute	24.0 ± 9.9	47.1 ± 21.0	< 0.001
Cyanoacrylate embolization	0 (0)	0 (0)
Five-day rebleeding	1 (1.4)	0 (0)	0.477
Esophageal varices	0 (0)	0 (0)
Gastric varices	1 (1.4)	0 (0)
Postinjection ulcers	0 (0)	0 (0)
One-year rebleeding	17 (23.6)	7 (19.4)	0.623
Esophageal varices	4 (5.6)	2 (5.6)
Gastric varices	9 (12.5)	3 (8.3)
Postinjection ulcers	4 (5.6)	2 (5.6)
Death	1 (1.4)	1 (2.8)	0.614
Endoscopic therapy costs, Chinese yuan	7523.4 ± 5719.4	11153.7 ± 7679.1	0.007

EUS: Endoscopic ultrasound; IQR: Interquartile range.

Full Size Table

Table 3 Subgroup analysis of the outcomes between clip-assisted endoscopic cyanoacrylate injection and endoscopic ultrasound-guided coil and cyanoacrylate injection management for patients with a maximum diameter of gastric fundal varices > 3 cm or 4 cm, mean ± SD/n (%)

Variable	Maximum diameter of gastric fundal varices ≥ 3 cm		Maximum diameter of gastric fundal varices ≥ 4 cm
Variable	Clip group (n = 30)	EUS group (n = 12)	Clip group (n = 18)	EUS group (n = 7)
Child-Pugh score	7.2 (1.3)	6.6 (1.7)	7.1 (1.2)	6.1 (1.3)
MELD score	9.1 (2.1)	7.9 (4.4)	8.8 (2.4)	7.0 (3.6)
Amount of cyanoacrylate, mL	2.5 ± 1.3	2.2 ± 0.4	2.8 ± 1.6	2.4 ± 0.6
Eradication of gastric fundal varices	25 (83.3)	10 (83.3)	15 (83.3)	6 (85.7)
Operating time, minute	24.1 (10.1)	44.9 (21.0)^b	27.4 (11.1)	40.8 (10.7)^a
Cyanoacrylate embolization	0 (0)	0 (0)	0 (0)	0 (0)
Five-day rebleeding	0 (0)	0 (0)	0 (0)	0 (0)
One-year rebleeding	6 (20.0)	2 (16.7)	3 (16.7)	1 (14.3)
Death	0 (0)	0 (0)	0 (0)	0 (0)
Endoscopic therapy costs, Chinese yuan	7147.7 ± 5425.1	12950.1 ± 6230.0^a	6764.0 ± 5639.5	12010.0 ± 6487.4^a

^aP < 0.05.

^bP < 0.001.

EUS: Endoscopic ultrasound; MELD: Model for end-stage liver disease.

Full Size Table

Citation: 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
URL: https://www.wjgnet.com/1007-9327/full/v31/i38/111363.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i38.111363