PRIMARY PROPHYLAXIS OF GASTRIC VARICEAL BLEEDING: DOES IT MATTER?-A SINGLE CENTER EXPERIENCE

Background: Gastric variceal bleeding occurs in 10-36% and is a life-threatening condition with a high mortality rate up to 20%. The role of primary prophylaxis of gastric variceal bleeding has not been established. The aim of our study was to evaluate the efficacy and safety of different treatment methods for the primary prophylaxis for gastric variceal bleeding.
Methods: A single center retrospective observational study evaluating patients with cardio-fundal gastric varices (GOV2 and IGV1) without prior bleeding between August 2016 and September 2022 were included. Patients were divided into four treatment groups: non-selective beta-blocker, endoscopic glue injection, EUS guided coil and glue injection, and observation without intervention. The primary outcome was bleeding from gastric varices on follow up. The secondary outcome was to assess any procedure-related complications. A descriptive analysis was performed with a Chi-square test for the distribution of bleeding among patients according to treatment. Logistic regression was conducted to calculate the odds ratio (OR) and 95% confidence intervals (CI) to estimate the effect of treatment on bleeding.
Results: A total of 252 patients with gastric varices were followed during the time. Patients were classified based on their treatment approaches: 26 patients received EUS-guided coil and glue injection, 5 patients received glue injection, 133 patients received beta blockers only, and 88 patients were observed without any treatment. Patients who underwent EUS-guided coil and glue injection exhibited a lower incidence of bleeding events compared to those who received beta blockers or remained under observation without treatment: 7.7% (0.01-25.1%), 26.3% (19.1-34.7%), and 30.7% (21.2-41.4%), respectively. No bleeding event was observed in patients who received glue injections. Univariable analyses revealed an 81% reduction in bleeding events among patients who received EUS-guided coil iand glue injection in contrast to those observed without treatment (OR=0.19, 95% CI: 0.042-0.85, P=0.03). Conversely, patients on beta blockers did not experience a statistically significant reduction in bleeding events compared with patients observed without treatment (OR=0.8, 95% CI: 0.44-1.46, P=0.5). No serious adverse events including anesthesia complications, procedural bleeding, or embolic events were noted due to the EUS guided coil and glue procedure.
Conclusion: EUS-guided coil and glue injection of large cardio-fundal gastric varices can be considered an effective and safe modality for primary prophylaxis of gastric varices. A prospective randomized trial with a larger population is needed to highlight the efficacy and safety of this technique.