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Background &amp; Aims <p>Cirrhosis with unexplained upper gastrointestinal bleeding (CUUGB) remains a persistent diagnostic and therapeutic challenge in the management of patients with cirrhosis. It is worth investigating whether EUS-guided cyanoacrylate injection (EUS-CYA) provides greater efficacy in the diagnosis and treatment of CUUGB compared to cyanoacrylate injection under direct endoscopy (DEI-CYA).</p> Methods <p>This study enrolled&#xa0;116 patients with CUUGB&#xa0;and employed a&#xa0;single-blind, prospective, parallel-group randomized design&#xa0;to assign participants into two arms: the&#xa0;DEI-CYA group (n = 58)&#xa0;and the&#xa0;EUS-CYA group (n = 58). Both groups of patients were followed up at 1, 3, and 6&#xa0;months postoperatively. In cases of rebleeding during this period, endoscopy was promptly repeated. The primary outcome was the comparison of rebleeding rates between the two groups of patients with CUUGB. Secondary outcomes included technical success rate, rate of vascular obliteration, Occurrence of complications during follow-up, and liver function status.</p> Results <p>Among the 116 enrolled patients, direct endoscopy revealed&#xa0;47 cases (40.51%)&#xa0;with gastric fundal&#xa0;red-color signs (RCS) and 27 cases (23.30%)&#xa0;with punctate erosions. Post-treatment, the&#xa0;EUS-CYA group&#xa0;demonstrated a significantly higher&#xa0;GV obliteration rate (82.76% vs. 65.52%, p = 0.035)&#xa0;and a lower&#xa0;long-term rebleeding rate (22.41% vs. 60.34%, p &lt; 0.01) compared to the DEI-CYA group. The&#xa0;cumulative incidence of rebleeding&#xa0;was lower in the&#xa0;EUS-CYA group&#xa0;(<i>p</i> = 0.003). Liver function improved following EUS-CYA, with significant increases in&#xa0;albumin (p = 0.038)&#xa0;and prothrombin time (PT, p = 0.009), whereas DEI-CYA improved only PT (p = 0.002). Multivariate analysis identified&#xa0;diabetes mellitus&#xa0;as an independent predictor of rebleeding (OR = 0.19; 95% CI: 0.06–0.65;&#xa0;<i>p</i> = 0.008). Notably,&#xa0;DEI-CYA&#xa0;was associated with&#xa0;significantly higher odds of rebleeding&#xa0;compared to&#xa0;EUS-CYA&#xa0;(OR = 0.23; 95% CI: 0.10–0.56;&#xa0;<i>p</i> = 0.001).</p> Conclusions <p>Compared with DEI-CYA, EUS-CYA demonstrates a significantly higher detection rate of bleeding etiology, superior vascular obliteration rates, and a lower incidence of rebleeding in patients with CUUGB.</p> <p>Chinese Clinical Trial Registry (ChiCTR) website (<a href="https://www.chictr.org.cn/">https://www.chictr.org.cn/</a>), Number ChiCTR2200058888.</p> Graphical Abstract <p></p>

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Endoscopic ultrasound versus conventional endoscopic cyanoacrylate glue injection for the management of gastrointestinal bleeding in cirrhosis: a randomized controlled trial

  • 期刊论文

  • 发表日期：

    2025年11月6日

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  • Yuchuan Bai,
  • Zhihong Wang,
  • Yaxian Kuai,
  • Xuecan Mei,
  • Jiang Kong,
  • Derun Kong

摘要

Background & Aims

Cirrhosis with unexplained upper gastrointestinal bleeding (CUUGB) remains a persistent diagnostic and therapeutic challenge in the management of patients with cirrhosis. It is worth investigating whether EUS-guided cyanoacrylate injection (EUS-CYA) provides greater efficacy in the diagnosis and treatment of CUUGB compared to cyanoacrylate injection under direct endoscopy (DEI-CYA).

Methods

This study enrolled 116 patients with CUUGB and employed a single-blind, prospective, parallel-group randomized design to assign participants into two arms: the DEI-CYA group (n = 58) and the EUS-CYA group (n = 58). Both groups of patients were followed up at 1, 3, and 6 months postoperatively. In cases of rebleeding during this period, endoscopy was promptly repeated. The primary outcome was the comparison of rebleeding rates between the two groups of patients with CUUGB. Secondary outcomes included technical success rate, rate of vascular obliteration, Occurrence of complications during follow-up, and liver function status.

Results

Among the 116 enrolled patients, direct endoscopy revealed 47 cases (40.51%) with gastric fundal red-color signs (RCS) and 27 cases (23.30%) with punctate erosions. Post-treatment, the EUS-CYA group demonstrated a significantly higher GV obliteration rate (82.76% vs. 65.52%, p = 0.035) and a lower long-term rebleeding rate (22.41% vs. 60.34%, p < 0.01) compared to the DEI-CYA group. The cumulative incidence of rebleeding was lower in the EUS-CYA group (p = 0.003). Liver function improved following EUS-CYA, with significant increases in albumin (p = 0.038) and prothrombin time (PT, p = 0.009), whereas DEI-CYA improved only PT (p = 0.002). Multivariate analysis identified diabetes mellitus as an independent predictor of rebleeding (OR = 0.19; 95% CI: 0.06–0.65; p = 0.008). Notably, DEI-CYA was associated with significantly higher odds of rebleeding compared to EUS-CYA (OR = 0.23; 95% CI: 0.10–0.56; p = 0.001).

Conclusions

Compared with DEI-CYA, EUS-CYA demonstrates a significantly higher detection rate of bleeding etiology, superior vascular obliteration rates, and a lower incidence of rebleeding in patients with CUUGB.

Chinese Clinical Trial Registry (ChiCTR) website (https://www.chictr.org.cn/), Number ChiCTR2200058888.

Graphical Abstract