Should we pursue high obliteration rate or high hemostatic rate in the therapy of gastric varices?

I read with interest the article regarding the therapy of gastric varices by Robles-Medranda et al. [1]. The investigators demonstrated that endoscopic ultrasonography (EUS)-guided coil embolization with cyanoacrylate injection achieved a lower rate of rebleeding and reintervention than coil treatment alone. The obliteration rates were up to 100 % and 90 %, respectively. These figures are definitely superior to those for standard endoscopic cyanoacrylate injection [2] [3] [4]. The acute hemostatic rates were not disclosed in the current trial. Five patients (17 %) in each group died of uncontrolled hemorrhage and the mortality rates were around 30 % at follow-up of only 12 months. These data seem to be no better than those for standard endoscopic cyanoacrylate injection [2] [3] [4].

EUS-guided coil embolization with cyanoacrylate injection appears rather appealing to endoscopists. However, this time-consuming, difficult technique may be more beneficial for a few selected individuals with severe gastric varices. Standard endoscopic cyanoacrylate injection has the advantage of being easy to perform and could be more accessible for endoscopists worldwide.

Publication History

Article published online:
28 July 2020

• References

• 1 Robles-Medranda C, Oleas R, Valero M. et al. Endoscopic ultrasonography-guided deployment of embolization coil and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial. Endoscopy 2020; 52: 268-275
• 2 Lo GH, Lai KH, Cheng JS. et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in management of bleeding gastric varices. Hepatology 2001; 33: 1060-1064
• 3 Lo GH, Liang HL, Chen WC. et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007; 39: 679-685
• 4 Wolfgang E, Shahrouki P, Alanis L. Management options for gastric variceal hemorrhage. JAMA Surgery 2019; 154: 540-548