Gastric varices management: Is clip-assisted glue injection a real-world alternative to endoscopic ultrasound-guided therapy?

Table 1 Summary of studies on the outcome of clip-assisted glue injection for gastric varices

Ref.	Design/sample size	Baseline characteristics	Key results	Comparison with con-ECI
Li et al[2]	Multicenter retrospective (n = 96). Clip-ECI: 46; Con-ECI: 50	IGV1 only: GRS: 59/66 (89.4%); Child-Pugh A/B; No prior variceal therapy	Hemostasis: 100% both groups; Rebleeding: 4.3% (clip) vs 18% (con) (P = 0.007); Obliteration: 100% (clip) vs 72% (con) (P < 0.001); Embolism: 1 cerebral (con-ECI)	Clip-ECI superior in rebleeding prevention and obliteration; similar safety overall
Zhang et al[3]	Multicenter observational (n = 61) Clip-ECI only	GOV2/IGV1 with CT-confirmed GRS; Mostly cirrhotics; some with large varices; Child-Pugh A/B/C	Technical success: 100%; Rebleeding: 22.8% overall; Embolism: None; Minor side effects only	-
Yu et al[4]	Single-center case series (n = 9) Clip-ECI only	GOV1/GOV2: 4/9 had spontaneous shunts; Child-Pugh A/B/C; Acute bleeding cases	Hemostasis: 100%; Rebleeding: 2/9 (22%); Embolism: None; Cyanoacrylate extrusion: 2 cases	-
Zhang et al[5]	Multicenter retrospective (n = 274). Clip-ECI: 148; Con-ECI: 126	GOV2/IGV1 with GRS; comparable age, sex, MELD, Child-Pugh	Rebleeding-free at 6 months: 88.6% (clip) vs 73.7% (con) (P = 0.002); Survival: NS; Fewer sessions in Clip-ECI (P = 0.015)	Clip-ECI offers better long-term control with fewer sessions
Wang et al[6]	Randomized controlled trial (n = 70). Clip-ECI: 35; Con-ECI: 35	GOV2/IGV1 with GRS (confirmed CT/MRI); Comparable age, sex, MELD, Child-Pugh	Embolism: 11.4% (clip) vs 42.9% (con) (P = 0.003); Symptomatic PE: 4 (con) vs 0 (clip); Rebleeding: 14.3% both Mortality: 1 death (con)	Clip-ECI is significantly safer for embolism; equally effective for bleeding

Con: Conventional; ECI: Endoscopic cyanoacrylate injection; GOV: Gastroesophageal varices; GRS: Gastro-renal shunt; IGV: Isolated gastric varices; PE: Pulmonary embolism; GOV2: Gastroesophageal varices type 2; IGV1: Isolated GV type 1; CT: Computed tomography; MRI: Magnetic resonance imaging; MELD: Model for end-stage liver disease.