El Dada A, El Khoury M, Stephan P, Nehme F. Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies. World J Gastrointest Endosc 2025; 17(12): 110168 [PMID: 41479939 DOI: 10.4253/wjge.v17.i12.110168]
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07768353
Submitted on:
December 17, 2025, 15:21
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Reader Comments:
The minireview by El Dada et al. offers a timely synthesis of endoscopic ultrasound (EUS)-guided coil embolization for gastric varices (GVs), highlighting its potential as a safer, precise alternative to traditional therapies like cyanoacrylate injection. Strengths include systematic comparisons with meta-analytic data (e.g., 96.7% obliteration rate for EUS-coil/cyanoacrylate vs. 70.6% for cyanoacrylate alone), practical technical details (coil selection, Doppler confirmation), real-world case illustrations, and cost-effectiveness analysis (1,831vs.11,000 hospitalization). However, limitations persist: reliance on retrospective/single-center data, absence of randomized controlled trials (RCTs) against TIPS/BRTO, and lack of long-term (>5 years) rebleeding/complication data (e.g., coil migration). The authors appropriately call for multicenter RCTs to standardize protocols, explore material combinations, and integrate predictive biomarkers. Despite gaps, the review compellingly argues for EUS-coil’s inclusion in GV guidelines, serving as a valuable reference for advancing therapeutic endoscopy with balanced analysis of efficacy, safety, and accessibility.