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Updated: Sep 30, 2025
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices
Manabu Nakazawa1, Yukinori Imai1, Kayoko Sugawara1
1Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan.
Insights
Endoscopic therapies effectively treat gastric variceal bleeding in cirrhosis patients. While generally successful, outcomes are poorer for those with hepatocellular carcinoma and portal venous tumor thrombosis.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Gastric variceal bleeding is a serious complication of cirrhosis.
- Effective therapeutic strategies are crucial for managing bleeding gastric varices and improving patient survival.
Purpose of the Study:
- To establish an effective therapeutic strategy for cirrhosis patients experiencing gastric variceal bleeding.
- To evaluate the outcomes of endoscopic interventions for different types of gastric varices.
Main Methods:
- Retrospective evaluation of 137 cirrhosis patients with bleeding gastric varices.
- Treatment included endoscopic variceal ligation, endoscopic injection sclerotherapy (EIS) with ethanolamine oleate or cyanoacrylate, and balloon-occluded retrograde transvenous obliteration (BRTO).
- Outcomes assessed included hemostasis, rebleeding rates, and survival rates.
Main Results:
- Successful hemostasis was achieved in 99.3% of patients.
- Gastric fundal varices (FV) showed significantly lower rebleeding rates (2.2% at 1 year) compared to gastroesophageal varices (GOV) (18.1% at 1 year).
- Survival rates were higher for FV patients (91.0% at 1 year) than GOV patients (79.7% at 1 year). Portal venous tumor thrombosis (PVTT) and alcoholic cirrhosis were risk factors for rebleeding; MELD score and PVTT impacted survival.
Conclusions:
- Endoscopic therapies, with or without BRTO, are effective strategies for managing gastric variceal bleeding.
- Favorable outcomes were observed, but patients with underlying hepatocellular carcinoma (HCC) and PVTT or severe liver damage had poorer prognoses.
Aim:
To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding.
Methods:
The outcomes of 137 patients with bleeding gastric varices were evaluated.
Results:
The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival.
Conclusions:
Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.
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