Clinical outcomes of clip-assisted endoscopic cyanoacrylate injection versus conventional endoscopic cyanoacrylate injection in treating gastric varices with a gastrorenal shunt

Abstract

Background and study aims

The optimal treatment for gastric varices (GVs) is a topic that remains definite for this study. This study compared the clinical outcomes of clip-assisted endoscopic cyanoacrylate injection (clip-ECI) to conventional endoscopic cyanoacrylate injection (con-ECI) for the treatment of GVs with a gastrorenal shunt.

Patients and methods

Data were collected retrospectively in five medical centers from 2015 to 2020. The patients were treated with con-ECI (n = 126) or clip-ECI (n = 148). Clinical characteristics and procedural outcomes were compared. Patients were followed until death, liver transplantation or 6 months after the treatment. The primary outcome was rebleeding, and the secondary outcome was survival.

Results

There were no significant differences in age, sex, etiology, shunt diameter and Child-Pugh classification between the two groups. Fewer GVs obliteration sessions were required in the clip-ECI group than in the con-ECI group (p = 0.015). The cumulative 6-month rebleeding-free rates were 88.6% in the clip-ECI group and 73.7% in the con-ECI group (p = 0.002). The cumulative 6-month survival rates were 97.1% in the clip-ECI group and 94.8% in the con-ECI group (p = 0.378).

Conclusions

Compared with con-ECI, clip-ECI appears more effective for the treatment of GVs with a gastrorenal shunt, which required less sessions and achieved a higher 6-month rebleeding-free rate.

Keywords:

• Gastric varices
• gastrorenal shunt
• rebleeding
• clip-assisted endoscopic cyanoacrylate injection

Acknowledgments

The authors thank Lianhui Zhao, Yifu Xia and Dongxin Hu for their assistance.

Author contributions

Study design: Chunqing Zhang, Mingyan Zhang; Data acquisition: Haijun Mou, Ruonan Sun, Jinming Yan, Qian Feng; Data analysis: Ruonan Sun, Guangjun Huang; Statistical analyses and consulting: Guangchuan Wang; Data interpretation: Haijun Mou, Mingyan Zhang, Yongjun Shi; Drafting of the manuscript: Mingyan Zhang; Revision for important intellectual content: Chunqing Zhang, Biguang Tuo, Derun Kong, Ping Li, Senlin Li.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [No. 81970533].