EUS-guided esophagogastric variceal obliteration: real-world cohort of three generation glue embolization (with...

Esophagogastric variceal bleeding (EGVB) remains life-threatening in portal hypertension. This real-world cohort documents stepwise EUS-guided glue embolization evolution for secondary prophylaxis of GOV-type EGVB, comparing sequential approaches: conventional ESVD (Endoscopic selective variceal devascularization), EUS-PCSS-D/P (EUS-guided variceal puncture with cyanoacrylate selective seal targeting the distal segment of the source vessel or perforating branch vessels), and EUS-PCSS-T (targeting the source vascular trunk). We aimed to evaluate the impact of these technical iterations on clinical outcomes.

Retrospective analysis of 89 patients undergoing secondary prophylaxis: ESVD (n = 30), EUS-PCSS-D/P (n = 29), EUS-PCSS-T (n = 30). Outcomes included rebleeding rates, variceal eradication efficiency, adverse events, and survival at 1/3/6 months post-procedure.

Baseline characteristics comparable (mean age 55-58 years; 50-70% male). No significant differences in EGV-related rebleeding (ESVD 23.3% vs. D/P 24.1% vs. T 13.3%), early (0-6.9%) or late rebleeding (13.3-17.2%), or all-cause GI rebleeding (13.3-33.3%). Rebleeding-free survival showed no intergroup differences overall (P = 0.221), within 180-day synchronized window (P = 0.567), or post-210-day landmark (P = 0.271). EGV eradication efficiency was superior with EUS-PCSS-T vs. ESVD or D/P (P < 0.001). Mild-moderate adverse events decreased in EUS-PCSS groups (3.5-6.7% vs. ESVD 23.3%; P = 0.033), with reduced glue use and punctures (P < 0.01).

EUS-PCSS-T demonstrated superior variceal eradication, reduced procedural burden, and improved safety versus earlier techniques. While rebleeding/survival differences were non-significant, it represents a technically optimized approach for GOV-type EGVB secondary prophylaxis. Prospective validation warranted.