Adding Clip Before Endoscopic Cyanoacrylate Injection Decreases Ectopic Embolisms in Gastric Varices: A Randomized...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Vascular Surgery

Background:

• Ectopic embolism is a severe complication of cyanoacrylate migration during endoscopic procedures.
• Gastric varices with gastrorenal shunts pose a risk for such embolic events.
• Endoscopic cyanoacrylate injection (ECI) is a treatment option, but embolism risk needs mitigation.

Purpose of the Study:

• To evaluate the efficacy of prior clipping in reducing ectopic embolism after ECI for gastric varices.
• To test the hypothesis that clip-assisted ECI is safer than conventional ECI regarding embolism.
• To compare the safety and efficacy of clip-assisted versus conventional ECI.

Main Methods:

• A multicenter, randomized controlled trial comparing clip-assisted ECI (Clip-ECI) with conventional ECI (Con-ECI).
• 35 patients were randomized to each group (Clip-ECI vs. Con-ECI).
• Computed tomography (CT) was used post-injection to detect cyanoacrylate migration and embolism.

Main Results:

• Clip-ECI demonstrated a significantly lower incidence of cyanoacrylate embolism (11.4%) compared to Con-ECI (42.9%).
• No symptomatic embolism occurred in the Clip-ECI group, whereas 4 patients in the Con-ECI group experienced symptomatic pulmonary embolism (1 death).
• Technical success, rebleeding rates, and survival rates were comparable between groups, with no reported clip-related bleeding.

Conclusions:

• Pre-procedural clipping effectively reduces the risk of ectopic embolism in patients undergoing ECI for gastric varices with portal-systemic shunts.
• Clip-assisted ECI offers an improved safety profile without compromising the therapeutic efficacy or survival outcomes.
• This technique represents a valuable advancement in managing gastric varices with reduced embolic complications.