Tang Yu, Lin Min, Zhuo Junyi, Zhong Xianfei
Department of Gastroenterology, The People's Hospital of Leshan, Southwest Medical University, No.639 Huian Road, Leshan, 614000, Sichuan, China.
Surg Endosc. 2025 May 19. doi: 10.1007/s00464-025-11804-3.
Gastric varices (GV) pose the potential risk of massive bleeding. Endoscopic ultrasound (EUS) guided real-time delivery of adhesives and devices has emerged as a promising therapeutic modality for GV but was limited in its generalizability due to the unavailability and lack of expertise of linear echoendoscopy. Therefore, we utilized the more readily available EUS mini-probe (EMP) in assisting cyanoacrylate (CYA) injection in the management of GV.
This is a retrospective cohort study from a single tertiary medical center. One hundred and thirty-three eligible patients were divided into three groups based on the treatment modalities including EMP-guided CYA injection via a dual-channel gastroscope (EMP-D group), EMP-guided injection via a single-channel gastroscope (EMP-S group) and direct endoscopic injection (DEI group). The clinical characteristics, procedural parameters, outcomes, adverse events and follow-up data were analyzed.
An overall statistical significance was achieved in the number of puncture site (p < 0.001), the number of instant blood return upon puncture (p = 0.001), cyanoacrylate dose (p = 0.004), late rebleeding rate (p = 0.018), post-injection ulcer (p = 0.005), and non-rebleeding interval (p = 0.026) among the three groups. Patients in EMP-D group exhibited a lower rate of post-injection ulcer than those in DEI group (p = 0.009). Procedural time of EMP-D was shorter than that of EMP-S (p < 0.001). Less amount of cyanoacrylate was needed per reinjection session in EMP-D than in DEI (p = 0.002).
EMP-guided cyanoacrylate injection exhibited superior effectiveness and safety to DEI, while use of the dual-channel gastroscope further enhanced the precision and efficiency.
胃静脉曲张（GV）存在大出血的潜在风险。内镜超声（EUS）引导下实时注射粘合剂和器械已成为一种有前景的GV治疗方式，但由于线性超声内镜不可用且缺乏专业知识，其普及受到限制。因此，我们利用更易于获得的EUS微型探头（EMP）辅助注射氰基丙烯酸酯（CYA）来治疗GV。
这是一项来自单一三级医疗中心的回顾性队列研究。根据治疗方式，133例符合条件的患者被分为三组，包括通过双通道胃镜进行EMP引导下CYA注射的组（EMP-D组）、通过单通道胃镜进行EMP引导下注射的组（EMP-S组）和直接内镜注射组（DEI组）。分析了临床特征、操作参数、结果、不良事件和随访数据。
三组在穿刺部位数量（p < 0.001）、穿刺时即时回血数量（p = 0.001）、氰基丙烯酸酯剂量（p = 0.004）、晚期再出血率（p = 0.018）、注射后溃疡（p = 0.005）和无再出血间隔时间（p = 0.026）方面总体具有统计学意义。EMP-D组患者注射后溃疡发生率低于DEI组（p = 0.009）。EMP-D组的操作时间短于EMP-S组（p < 0.001）。EMP-D组每次再注射所需的氰基丙烯酸酯量少于DEI组（s = 0.002）。
EMP引导下注射氰基丙烯酸酯比直接内镜注射具有更高的有效性和安全性，而使用双通道胃镜进一步提高了精度和效率。
