Efficacy of endoscopic ultrasound-guided coil placement combined with tissue adhesive injection in treatment of gastric varices with spontaneous shunt
Objective To investigate the efficacy,safety,and cost-effectiveness of endoscopic ultrasound(EUS)-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt.Methods A retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration(BRTO)combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022.The two surgical procedures were compared in terms of efficacy(technical success rate,5-day rebleeding rate,1-year rebleeding rate,and time to rebleeding),safety(the incidence rate of ectopic embolism,the amount of tissue adhesive used,and the amount of lauromacrogol used),and cost-effectiveness(hospital costs and length of hospital stay).The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The Kaplan-Meier method was used to estimate the rebleeding.The chi-square test was used for comparison of categorical data between two groups.Results A total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection,with a technical success rate of 100%,a median amount of 2.5 mL tissue adhesive used,a median amount of 11.0 mL lauromacrogol used,a mean length of hospital stay of 14.88±3.21 days,a mean hospital cost of 32 660.00±4 602.07 yuan,and a 5-day rebleeding rate of 0%;among these patients,2 were lost to follow-up,and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0%and a median time to rebleeding of 689 days.A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection,with a technical success rate of 100%;a median amount of 5.0 mL tissue adhesive used during surgery,which was significantly higher than that used in EUS(U=39.000,P<0.001);a median amount of 10.5 mL lauromacrogol used during surgery;a mean length of hospital stay of 15.38±4.94 days;a mean hospital cost of 57 583.47±18 955.40 yuan,which was significantly higher than that used in EUS(t=-6.310,P<0.001);a 5-day rebleeding rate of 0%.No patient was lost to follow-up,and all 14 patients had an incidence rate of ectopic embolism of 0%and a median time to rebleeding of 244.50 days,with no significant difference between the two groups(χ2=1.448,P=0.229).Conclusion EUS-guided coil placement combined with tissue adhesive injection is a relatively safe and effective technique for the treatment of gastric variceal bleeding and has a high technical success rate,a low incidence rate of serious adverse events,and similar efficacy to BRTO,with higher safety and cost-effectiveness.
Esophageal and Gastric VaricesSpontaneous Portosystemic ShuntEndoscopic UltrasoundBalloon-Occluded Retrograde Transvenous Obliteration
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