P0923 - EUS-Guided Coil + Cyanoacrylate Cuts Post-Procedure Failures by Two-Thirds versus Single-Agent Therapy for Gastric Varices: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Emil Vergis Philip, MBBS1, Ashesh Das, MBBS2, Venkata Dileep Kumar Veldi, MBBS3, Shankar Biswas, MD4, Shayan Mahapatra, MD5, Jana Al Jnainati, MD6, Sailesh I S. Kumar, MBBS7, Abed Saeed, MD8, Bushra Mia Khail, MD9, Abhilash Veerendra Kumar, MBBS10, Ali Naseem, 11, Premsai Kadapa, MBBS12 1Madras Medical College, Kottayam, Kerala, India; 2KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 3Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 4Ivano-Frankivsk National Medical University, Ukraine, Meerut, Uttar Pradesh, India; 5Aiken Regional Medical Center, Graniteville, SC; 6University of Milan–Bicocca: Universita degli Studi di Milano-Bicocca, Bergamo, Lombardia, Italy; 7Madras medical college, Birmingham, AL; 8Kabul University of Medical Sciences, North York, ON, Canada; 9Kabul university of medical science, Toronto, ON, Canada; 10Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India; 11King edward medical university lahore, Okara, Punjab, Pakistan; 12Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India Introduction: Gastric variceal bleeding remains one of the most lethal sequelae of portal hypertension, with mortality that can exceed esophageal varices despite lower incidence. Endoscopic injection of cyanoacrylate or deployment of embolization coils under EUS guidance have each improved hemostasis, yet both modalities alone still permit re-bleeding and variceal recurrence that demand repeat intervention. Combining coils providing a durable scaffold with cyanoacrylate and achieving rapid thrombosis promises synergistic obliteration, but its incremental benefit has not been clearly quantified. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing EUS-guided coil + cyanoacrylate Vs either alone for gastric varices through May 2025. Data were analysed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0. Results: Across three randomized trials (n = 142), EUS-guided coil + cyanoacrylate (Coil+CYA) achieved the same high technical success as single-agent therapy—complete ultrasound-confirmed obliteration in 93 % vs 88 % of cases (RR 1.06, 95 % CI 0.95-1.18)—yet delivered markedly better clinical durability: re-bleeding fell from 17 % to 3 % (RR 0.21, 0.06-0.77), variceal recurrence from 28 % to 10 % (RR 0.38, 0.18-0.80) and the need for re-intervention from 42 % to 20 % (RR 0.48, 0.28-0.83). Heterogeneity was absent for every endpoint (I² = 0 %), translating into a robust, roughly two-thirds reduction in post-procedure failures without compromising initial eradication. Discussion: EUS-guided Coil + CYA maintains the same near-universal obliteration achieved by monotherapy yet cuts re-bleeding, variceal recurrence, and re-intervention by roughly two-thirds—consistently across trials without heterogeneity. This dual approach therefore addresses both the mechanical and hemostatic vulnerabilities of single-agent therapy, offering an immediate strategy to reduce emergency re-endoscopies and associated transfusion, ICU stay, and mortality. Our pooled RCT-level evidence provides a compelling signal strong enough to inform guideline updates, and it sets the stage for larger multicenter trials powered for survival and cost-effectiveness.
Figure: Figure Showing Forest Plots of Any Re-bleeding Event, Complete Gastric varix Obliteration, Need for re-intervention, Varix Re-apperance.
Figure: Prisma Flowchart
Disclosures: Emil Vergis Philip indicated no relevant financial relationships. Ashesh Das indicated no relevant financial relationships. Venkata Dileep Kumar Veldi indicated no relevant financial relationships. Shankar Biswas indicated no relevant financial relationships. Shayan Mahapatra indicated no relevant financial relationships. Jana Al Jnainati indicated no relevant financial relationships. Sailesh Kumar indicated no relevant financial relationships. Abed Saeed indicated no relevant financial relationships. Bushra Mia Khail indicated no relevant financial relationships. Abhilash Veerendra Kumar indicated no relevant financial relationships. Ali Naseem indicated no relevant financial relationships. Premsai Kadapa indicated no relevant financial relationships.
Emil Vergis Philip, MBBS1, Ashesh Das, MBBS2, Venkata Dileep Kumar Veldi, MBBS3, Shankar Biswas, MD4, Shayan Mahapatra, MD5, Jana Al Jnainati, MD6, Sailesh I S. Kumar, MBBS7, Abed Saeed, MD8, Bushra Mia Khail, MD9, Abhilash Veerendra Kumar, MBBS10, Ali Naseem, 11, Premsai Kadapa, MBBS12. P0923 - EUS-Guided Coil + Cyanoacrylate Cuts Post-Procedure Failures by Two-Thirds versus Single-Agent Therapy for Gastric Varices: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
