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
Abstract
BACKGROUND

Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension (LSPH). The hemorrhage is fatal and requires safe and effective interventions.

AIM

To evaluate the clinical safety and efficacy of modified endoscopic ultrasound (EUS)-guided selective N-butyl-2-cyanoacrylate (NBC) injections for gastric variceal hemorrhage in LSPH.

METHODS

A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted. Preoperative EUS evaluations were performed. Enrolled patients were divided into modified and conventional groups according to the NBC injection technique. The final selection of NBC injection technique depended on the patients’ preferences and clinical status. The technical and clinical success rates, operation time, NBC doses, perioperative complications, postoperative hospital stay, and recurrent bleeding rates were analyzed, respectively.

RESULTS

A total of 27 patients were enrolled. No statistically significant differences were observed between the two groups regarding baseline characteristics. 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 two groups had no significant difference in the technical and clinical success rates, perioperative complications, postoperative hospital stay, and recurrent bleeding rates.

CONCLUSION

Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage, with advantages of reduced injection dose and no radiation risk. Drawbacks were time consumption and technical challenge.

Keywords: Endoscopic ultrasound, Selective, N-butyl-2-cyanoacrylate, Gastric varices, Hemorrhage, Left-sided portal hypertension

Core Tip: Gastric variceal hemorrhage is a severe and critical complication of left-sided portal hypertension (LSPH). Endoscopic ultrasound (EUS)-guided interventions are emerging endoscopic treatments with diagnostic and therapeutic potential. Our study revealed that EUS-guided selective N-butyl-2-cyanoacrylate injection is a safe and effective treatment alternative for patients with LSPH-induced gastric variceal hemorrhage, with reduced N-butyl-2-cyanoacrylate doses and satisfactory technical and clinical success rates.