Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2024; 16(1): 29-36
Published online Jan 16, 2024. doi: 10.4253/wjge.v16.i1.29
Safety and efficacy of modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension
Yan Zeng, Jian Yang, Jun-Wen Zhang
Yan Zeng, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Jian Yang, Department of Gastroenterology, Changdu People's Hospital of Xizang, Changdu 854000, Tibet Autonomous Region, China
Jian Yang, Jun-Wen Zhang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Zeng Y, Yang J and Zhang JW conceptualized and designed the research; Zeng Y and Yang J performed the literature search, analyzed the data, and wrote the original manuscript; Yang J and Zhang JW performed the endoscopic procedures and edited the final manuscript; all authors have read and approved the final manuscript.
Supported by Program for Youth Innovation in Future Medicine, Chongqing Medical University, China, No. W0138.
Institutional review board statement: This retrospective study received approval from the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Yang, MD, PhD, Associate Chief Physician, Deputy Director, Department of Gastroenterology, Changdu People's Hospital of Xizang, No. 168 South Road Gate, Karuo District, Changdu 854000, Tibet Autonomous Region, China. yangjian@hospital.cqmu.edu.cn
Received: October 6, 2023
Peer-review started: October 6, 2023
First decision: December 6, 2023
Revised: December 7, 2023
Accepted: December 27, 2023
Article in press: December 27, 2023
Published online: January 16, 2024
ARTICLE HIGHLIGHTS
Research background

Left-sided portal hypertension (LSPH) is often secondary to pancreatic diseases, including pancreatitis and pancreatic tumors. Given normal liver function and no obvious clinical symptoms in LSPH patients, gastric varices (GV) have received little attention.

Research motivation

To study the clinical value of our previously reported modified endoscopic ultrasound (EUS)-guided selective N-butyl-2-cyanoacrylate (NBC) injection procedure in patients with LSPH-induced gastric variceal hemorrhage.

Research objectives

To evaluate and compare the clinical safety and efficacy between modified EUS-guided selective NBC injections and conventional endoscopic NBC injection procedures for gastric variceal hemorrhage in LSPH.

Research methods

LSPH patients from the First Affiliated Hospital of Chongqing Medical University were retrospectively reviewed and analyzed from October 2019 to September 2023. The technical and clinical success rates, operation time, NBC doses, perioperative complications, postoperative hospital stay, and recurrent bleeding rates of the modified and conventional groups were analyzed.

Research results

The technical success rate was 100% for both types of injection procedures, and clinical success rates were 90.9% and 100% in the modified and conventional groups, respectively (P = 0.41). In comparison to patients in the conventional group, patients in the modified group demonstrated significantly reduced NBC doses (2.0 ± 0.6 mL vs 3.1 ± 1.0 mL; P = 0.004) and increased endoscopic operation time (71.9 ± 11.9 min vs 22.5 ± 6.7 min; P < 0.001). Meanwhile, the perioperative complications, postoperative hospital stay, and recurrent bleeding rates for patients in the modified group were 0%, 4.4 ± 1.6 d, and 9.1%, respectively, vs 6.3%, 5.8 ± 2.2 d, and 18.8% for those in the conventional group.

Research conclusions

The modified EUS-guided selective NBC injection procedure demonstrated reduced injection dose and no increased perioperative complications compared to conventional endoscopic NBC injection procedures. Thus, it is safe and effective in treating patients with LSPH-induced gastric variceal hemorrhage.

Research perspectives

This present study built on our prior research and compared the safety and efficacy of a modified EUS-guided selective NBC injection procedure for gastric variceal hemorrhage in LSPH with conventional endoscopic NBC injection procedures. EUS-guided advanced endoscopic procedures will undoubtedly be the future direction of endoscopic treatment.