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Background and Aims <p>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.</p> Methods <p>Retrospective analysis of 89 patients undergoing secondary prophylaxis: ESVD (n = 30), EUS-PCSS-D/P (<i>n</i> = 29), EUS-PCSS-T (<i>n</i> = 30). Outcomes included rebleeding rates, variceal eradication efficiency, adverse events, and survival at 1/3/6&#xa0;months post-procedure.</p> Results <p>Baseline characteristics comparable (mean age 55–58&#xa0;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 (<i>P</i> = 0.221), within 180-day synchronized window (<i>P</i> = 0.567), or post-210-day landmark (<i>P</i> = 0.271). EGV eradication efficiency was superior with EUS-PCSS-T vs. ESVD or D/P (<i>P</i> &lt; 0.001). Mild-moderate adverse events decreased in EUS-PCSS groups (3.5–6.7% vs. ESVD 23.3%;&#xa0;<i>P</i> = 0.033), with reduced glue use and punctures (<i>P</i> &lt; 0.01).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月4日

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  • Mengran Zhang,
  • Julong Hu,
  • Yu Jiang,
  • Zhenglin Ai,
  • Yijun Lin,
  • Yuling Zhou,
  • Ping Li

摘要

Background and Aims

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.

Methods

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.

Results

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).

Conclusions

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.