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Background <p>Bleeding from isolated gastric varices type 1 (IGV-1) with gastrorenal shunts (GRS) carries a high risk. Although EUS-guided coil-assisted cyanoacrylate (CYA) injection is effective, coil use raises concerns regarding long-term safety and cost. This study was performed to evaluate the feasibility, efficacy, and safety of EUS-guided coil-free direct CYA injection for managing IGV-1 with GRS.</p> Methods <p>This single-center, retrospective case series included 15 consecutive patients with IGV-1 and GRS who underwent EUS-guided coil-free direct CYA injection between November 2024 and May 2025. Under real-time EUS/Doppler guidance, the primary feeding vessel was punctured, and a modified “sandwich” technique was employed; conventional gastroscopic direct CYA injection (CGD-CYA injection) was performed for residual varices in selected patients. The primary outcomes were technical success, variceal obliteration at 6&#xa0;months, and 6-week rebleeding rates.</p> Results <p>The technical success rate was 100% (15/15). Fourteen patients (93.33%) achieved complete variceal obliteration on follow-up imaging (median 210&#xa0;days). The early rebleeding rate (within 6&#xa0;weeks) was 13.33%, with no late rebleeding occurring thereafter. The rebleeding-free survival rate was 80.00% during follow-up.&#xa0;The median EUS-guided CYA injection volume was 4.00&#xa0;mL. No major adverse events, including symptomatic ectopic embolism, were observed. Minor adverse events—transient fever (33.33%) and abdominal pain (40.00%)—were self-limiting. </p> Conclusion <p>EUS-guided coil-free direct CYA injection appears to be a feasible and safe alternative for managing IGV-1 with GRS, demonstrating high technical success and effective obliteration. CGD-CYA injection serves as a valuable supplementary treatment for residual varices, further improving obliteration efficacy. Despite an observed early rebleeding rate, the technique may potentially offer a valuable option, particularly in resource-limited settings.</p>

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EUS-guided coil-free cyanoacrylate injection for the management of isolated gastric varices type 1 with gastrorenal shunts: The first case series

  • 期刊论文

  • 发表日期：

    2026年5月12日

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

摘要

Background

Bleeding from isolated gastric varices type 1 (IGV-1) with gastrorenal shunts (GRS) carries a high risk. Although EUS-guided coil-assisted cyanoacrylate (CYA) injection is effective, coil use raises concerns regarding long-term safety and cost. This study was performed to evaluate the feasibility, efficacy, and safety of EUS-guided coil-free direct CYA injection for managing IGV-1 with GRS.

Methods

This single-center, retrospective case series included 15 consecutive patients with IGV-1 and GRS who underwent EUS-guided coil-free direct CYA injection between November 2024 and May 2025. Under real-time EUS/Doppler guidance, the primary feeding vessel was punctured, and a modified “sandwich” technique was employed; conventional gastroscopic direct CYA injection (CGD-CYA injection) was performed for residual varices in selected patients. The primary outcomes were technical success, variceal obliteration at 6 months, and 6-week rebleeding rates.

Results

The technical success rate was 100% (15/15). Fourteen patients (93.33%) achieved complete variceal obliteration on follow-up imaging (median 210 days). The early rebleeding rate (within 6 weeks) was 13.33%, with no late rebleeding occurring thereafter. The rebleeding-free survival rate was 80.00% during follow-up. The median EUS-guided CYA injection volume was 4.00 mL. No major adverse events, including symptomatic ectopic embolism, were observed. Minor adverse events—transient fever (33.33%) and abdominal pain (40.00%)—were self-limiting.

Conclusion

EUS-guided coil-free direct CYA injection appears to be a feasible and safe alternative for managing IGV-1 with GRS, demonstrating high technical success and effective obliteration. CGD-CYA injection serves as a valuable supplementary treatment for residual varices, further improving obliteration efficacy. Despite an observed early rebleeding rate, the technique may potentially offer a valuable option, particularly in resource-limited settings.