Clip-first emergency hemostasis for acute esophagogastric variceal bleeding: a retrospective comparative study

Active esophagogastric variceal bleeding can obscure the endoscopic field and make definitive therapy difficult during emergency gastroscopy. We evaluated a clip-first strategy designed to obtain immediate mechanical control before local cyanoacrylate reinforcement or staged secondary prophylaxis.

We retrospectively analyzed 115 acute bleeding episodes among 102 adults treated at a single tertiary center. Episodes were assigned to a clip-first group (n = 42) or a conventional emergency endoscopic therapy group without clip-first control (n = 73). Variceal anatomy was reclassified as esophageal varices (EV) only or by the Sarin system for gastric varices. Primary outcomes were technical success and endoscopic hemostasis time; secondary outcomes included injection material use, rebleeding, adverse events, length of stay, and mortality.

Technical success was achieved in all episodes. Hemostasis time was shorter in the unadjusted analysis (10.60 ± 5.14 vs. 12.84 ± 6.66 min; P = 0.049), but the adjusted difference was not statistically significant (- 1.96 min, 95% confidence interval [CI] -4.17 to 0.25; P = 0.081). Adjusted reductions in cyanoacrylate (- 0.79 mL, 95% CI -1.15 to -0.44; P < 0.001) and lauromacrogol (- 4.10 mL, 95% CI -6.82 to -1.37; P = 0.004) remained significant. No perforation, ectopic embolism, local tissue necrosis, or death was recorded among patients with documented status.

Clip-first emergency hemostasis was feasible, with no significant difference in adjusted hemostasis time and with reduced cyanoacrylate and lauromacrogol use. Larger prospective randomized controlled trials are needed to clarify the clinical significance of this strategy, including its effects on hemostatic efficiency, and rebleeding.