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Endoscopic ultrasonography-guided injection of cyanoacrylate in the treatment of gastroesophageal varices type 1: a single-center randomized study

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Abstract

Background and aim

First, it has been demonstrated that endoscopic ultrasonography (EUS)-guided cyanoacrylate (CYA) injection (EUS-CYA) has greater efficacy than direct endoscopic injection of cyanoacrylate (DEI-CYA) for treating type 1-isolated gastric varices. However, it is necessary to conduct further studies to determine whether EUS has any advantage over the current guidelines for treating gastroesophageal varices type 1 (GOV1). Second, liver function is an important prognostic factor in patients with liver cirrhosis. Therefore, we evaluated the liver function of patients treated with EUS-CYA.

Methods

In a single-center study, a prospective cohort from February 2021 to September 2022 involving 89 patients with cirrhosis with GOV1 were assigned to undergo EUS-CYA (n = 45) or DEI-CYA (n = 44). The success rate of CYA injection, the rate of overall rebleeding, the rate of reintervention, the complications during the follow-up period, and the liver function were compared.

Results

In both groups, 100% of the operations were successful. The follow-up time of the two groups was 290 (153–398) days and 267 (177–416) days, respectively. In the EUS group, the perforating veins had an average diameter of 7.0 ± 2.7 mm, and they had a 100% occlusion rate. A statistically significant difference was found between the two groups regarding the number of sessions needed to eradicate GV (p = 0.005, pairwise comparisons were conducted using the Bonferroni correction method.), the late rebleeding rate after EUS-CYA [n = 3 (6.7%) vs n = 10 (22.7%); p = 0.032], and the incidence of postinjection ulcers [n = 4 (8.9%) vs n = 12 (27.3); p = 0.023)]. Following EUS or DEI-CYA treatment, the patient’s liver function did not show any significant deterioration or decline.

Conclusion

EUS-CYA has a higher eradication success rate and fewer complications, recurrences, and rebleeding episodes than DEI-CYA used for GOV1 treatment. In addition, EUS-CYA did not impair liver function.

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Acknowledgements

The author thanks Jiangrui Cheng for his contribution in the statistical portion of this paper and appreciates Xianfu Lu’s contribution in the field of anesthesia.

Funding

The sixth batch of health and appropriate technology promotion projects in Anhui Province, new technology of comprehensive diagnosis and treatment of esophagogastric varices under endoscopy (SYJS202103); NSF Project, MAIT Cells induce neutrophil aging through gut microbiota. A novel mechanism for the progression of alcoholic liver disease (82270623).

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Author notes

  1. Zhihong Wang and Zhuang Zeng have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Digestive Diseases of Anhui Province, Jixi Road 218, Hefei, 230022, Anhui, China

    Zhihong Wang, Zhuang Zeng, Lihong Chen, Chen Shi, Jing Jin, Fumin Zhang, Qianqian Zhang, Xuecan Mei & Derun Kong

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  1. Zhihong Wang
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Correspondence to Derun Kong.

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Zhihong Wang, Zhuang Zeng, Lihong Chen, Chen Shi, Jing Jin, Fumin Zhang, Qianqian Zhang, Xuecan Mei, and Derun Kong have no conflicts of interest or financial ties to disclose.

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Wang, Z., Zeng, Z., Chen, L. et al. Endoscopic ultrasonography-guided injection of cyanoacrylate in the treatment of gastroesophageal varices type 1: a single-center randomized study. Surg Endosc 37, 8277–8284 (2023). https://doi.org/10.1007/s00464-023-10342-0

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