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EUS GUIDED COIL AND GLUE IS SUPERIOR TO ENDOSCOPIC CYANOACRYLATE GLUE IN A SUBSET OF PATIENTS WITH GASTRIC VARICES- A RETROSPECTIVE ANALYSIS
Date
May 19, 2024
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BACKGROUND
Endoscopic cyanoacrylate glue injection is the gold standard for obliteration of gastric varices Endoscopic ultrasound (EUS) guided coil and glue therapy is being increasingly used in management of gastric varices. In this study, we compare the efficacy of EUS guided coil and glue injection with endoscopic glue injection for patients with gastric varices.
Methods
Data was extracted from prospectively maintained database and retrospective analysed. Details were tabulated of patients who underwent endoscopic glue therapy for gastric varices as well as EUS guided coil and glue injection, between 2017 to 2023. Patients were divided in two groups, Group A for patients who underwent EUS guided procedure and Group B for Endoscopic cyanoacrylate glue. Data collected included baseline characteristics, gastric varix classification as per Sarin’s classification, size of varix, CTP score, MELD Score, associated portal vein or splenic vein thrombosis, and presence or absence of hepatocellular carcinoma (HCC). Outcomes measures were technical success defined by complete obliteration as evidenced by loss of doppler signal on EUS or hardness on probing in case of endoscopic therapy. Descriptive analysis of quantitative parameters was expressed as means and standard deviation. Categorical data were expressed as absolute number and percentage. Independent Student t – test was used for testing of mean between independent groups. p-value < 0.05 was considered statistically significant. Multiple variables were analysed using regression analysis. Informed consent was taken for all the procedures.
Results
Group A had 136 patients and Group B had 310 patients. The mean age of patients was 42.5 years in group A and 46 years in group B. The mean CTP and MELD scores in group A was 9.4 and 16 respectively whereas in group B, it was 9.1 and 15 respectively. The baseline characterstics were comparable. The mean size of gastric varix in group A was 21.2 mm and in 15 mm in group B. The mean number of coils used in group A was 3.1 and average glue injected as 1.4 ml. In group B, average glue required was 2.6 ml. Technical success was higher in patients in group A at 98.9 % whereas in group B it was 89.1 % (P value- 0.0056) Clinical success was seen in 92.5% patients in group A and 85% patients with group B. Mean follow up was seen for 174 days. In multivariate analysis, patients with portal vein thrombosis, HCC, higher CTP score(>9), and higher size of varix(>18mm) were associated with better clinical success with EUS guided coil and glue.
Conclusions
EUS Guided Coil and glue therapy is superior to endoscopic cyanoacrylate glue injection for management of gastric varices particularly in patients with associated portal or splenic vein thrombosis, higher CTP scores(>9), and larger varices (>18mm).
Endoscopic cyanoacrylate glue injection is the gold standard for obliteration of gastric varices Endoscopic ultrasound (EUS) guided coil and glue therapy is being increasingly used in management of gastric varices. In this study, we compare the efficacy of EUS guided coil and glue injection with endoscopic glue injection for patients with gastric varices.
Methods
Data was extracted from prospectively maintained database and retrospective analysed. Details were tabulated of patients who underwent endoscopic glue therapy for gastric varices as well as EUS guided coil and glue injection, between 2017 to 2023. Patients were divided in two groups, Group A for patients who underwent EUS guided procedure and Group B for Endoscopic cyanoacrylate glue. Data collected included baseline characteristics, gastric varix classification as per Sarin’s classification, size of varix, CTP score, MELD Score, associated portal vein or splenic vein thrombosis, and presence or absence of hepatocellular carcinoma (HCC). Outcomes measures were technical success defined by complete obliteration as evidenced by loss of doppler signal on EUS or hardness on probing in case of endoscopic therapy. Descriptive analysis of quantitative parameters was expressed as means and standard deviation. Categorical data were expressed as absolute number and percentage. Independent Student t – test was used for testing of mean between independent groups. p-value < 0.05 was considered statistically significant. Multiple variables were analysed using regression analysis. Informed consent was taken for all the procedures.
Results
Group A had 136 patients and Group B had 310 patients. The mean age of patients was 42.5 years in group A and 46 years in group B. The mean CTP and MELD scores in group A was 9.4 and 16 respectively whereas in group B, it was 9.1 and 15 respectively. The baseline characterstics were comparable. The mean size of gastric varix in group A was 21.2 mm and in 15 mm in group B. The mean number of coils used in group A was 3.1 and average glue injected as 1.4 ml. In group B, average glue required was 2.6 ml. Technical success was higher in patients in group A at 98.9 % whereas in group B it was 89.1 % (P value- 0.0056) Clinical success was seen in 92.5% patients in group A and 85% patients with group B. Mean follow up was seen for 174 days. In multivariate analysis, patients with portal vein thrombosis, HCC, higher CTP score(>9), and higher size of varix(>18mm) were associated with better clinical success with EUS guided coil and glue.
Conclusions
EUS Guided Coil and glue therapy is superior to endoscopic cyanoacrylate glue injection for management of gastric varices particularly in patients with associated portal or splenic vein thrombosis, higher CTP scores(>9), and larger varices (>18mm).
Presenter
Medanta - The Medicity
