Gastric varices management - Is clip-assisted glue injection a real-world alternative to endoscopic ultrasound-guided therapy?

Sep 28, 2026

Uploaded by Rizky

Gastric variceal bleeding remains a life-threatening complication of portal hypertension, with ongoing debate over optimal endoscopic therapy. Conventional endoscopic cyanoacrylate injection (ECI) is effective but limited by ectopic embolism risk, especially with gastrorenal shunts. Clip-assisted ECI (clip-ECI) reduces embolic risk while preserving hemostatic efficacy. Evidence from a comparative propensity-matched study and supporting literature indicates comparable obliteration and rebleeding outcomes, with fewer embolic events, shorter procedures, fewer sessions, and lower costs, while larger standardized studies are still needed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Letter to the Editor

Core Tip

Abstract

Key Words

Main Letter Discussion

Study Limitations

| W | J | G | World Journal of
Gastroenterology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2025 December 14; 31(46): 114149 DOI: 10.3748/wjg.v31.i46.114149 ISSN 1007-9327 (print) ISSN 2219-2840 (online) LETTER TO THE EDITOR Gastric varices management: Is clip-assisted glue injection a realworld alternative to endoscopic ultrasound-guided therapy? Suprabhat Giri, Kshitij Kumar Specialty type: Gastroenterology and hepatology Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade A, Grade C Novelty: Grade A, Grade D Creativity or Innovation: Grade A, Grade D Scientific Significance: Grade A, Grade C P-Reviewer: Ibrahim M, MD, Associate Professor, Chief Physician, Egypt; Zhao JL, MD, Assistant Professor, China Received: September 15, 2025 Revised: October 19, 2025 Accepted: October 31, 2025 Published online: December 14, 2025 Processing time: 89 Days and 4.5 Hours Suprabhat Giri, Kshitij Kumar, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India Co-first authors: Suprabhat Giri and Kshitij Kumar. Corresponding author: Suprabhat Giri, Associate Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5, KIIT Rd, Patia, Bhubaneswar 751024, Odisha, [India.](India. supg19167@gmail.com)[ supg19167@gmail.com](India. supg19167@gmail.com) Abstract Gastric variceal (GV) bleeding remains a life-threatening complication of portal hypertension, with ongoing debate regarding the optimal endoscopic therapy. Conventional endoscopic cyanoacrylate injection (ECI) is effective but limited by the risk of ectopic embolism, particularly in the presence of gastrorenal shunts. Clip-assisted ECI (clip-ECI) has emerged as a novel modification designed to reduce embolic risk while maintaining hemostatic efficacy. We appraised the recent study by Xiong et al, which compared clip-ECI with endoscopic ultrasoundguided coil and cyanoacrylate injection in 108 propensity-matched patients with cardiofundal varices and shunts. Both techniques demonstrated comparable efficacy, with obliteration rates exceeding 90% and similar one-year rebleeding rates. Importantly, no embolic events were reported. These findings are consistent with prior studies, including multicenter cohorts and a recent randomized controlled trial, which highlight clip-ECI as a safe, effective, and efficient technique, with advantages of shorter procedure times, fewer sessions, and lower costs. While endoscopic ultrasound (EUS)-guided therapy offers precision in expert hands, clip-ECI provides a practical, accessible alternative, particularly in resource-limited settings. Larger prospective studies with standardized definitionsand cost-effectiveness analyses are needed to refine treatment algorithms. ClipECI represents a promising “flow-control assisted” strategy and a real-world alternative to EUS-based therapies for GV. Key Words: Gastric varices; Endoscopy; Gastrointestinal; Tissue adhesives; Hemostasis; Endoscopic; Endoscopic ultrasound ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. WJG [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 14, 2025 Volume 31 Issue 46 Giri S et al. Appraisal of clip-ECI vs EUS-C+G for GV Core Tip: Clip-assisted cyanoacrylate injection (clip-ECI) is a safe, effective, and practical method for managing cardiofundal gastric varices, particularly in patients with gastrorenal shunts. Evidence from multicenter cohorts and a randomized trial shows comparable hemostasis to conventional and endoscopic ultrasound (EUS)-guided techniques, with a markedly lower risk of ectopic embolism. By restricting blood flow and improving variceal obliter

FAQs

What problem does clip-assisted cyanoacrylate injection (clip-ECI) aim to address in gastric varices?

It targets the risk of ectopic embolism associated with conventional endoscopic cyanoacrylate injection (ECI), particularly in patients with gastrorenal shunts, while maintaining hemostatic effectiveness.

How does clip-ECI compare with endoscopic ultrasound-guided coil and cyanoacrylate injection (EUS-C+G) in efficacy?

The summarized comparative study reports similar obliteration rates (over 90%) and comparable one-year rebleeding rates between clip-ECI and EUS-C+G.

Why may clip-ECI be a practical alternative in resource-limited settings?

The document notes advantages such as shorter procedure time, fewer sessions, and lower costs, making clip-ECI more accessible when EUS resources are limited, even though EUS therapy can offer precision in expert hands.

Sep 28, 2026

Uploaded by Rizky