In individuals having elevated-risk gastric varices, the endoscopic ultrasound-guided coil and cyanoacrylate injection is very effective for primary prophylaxis of gastric variceal bleeding and is coupled with a low rate of adverse events.

An observational single-center study was carried out to examine the efficacy and safety of endoscopic ultrasound-guided coil and glue injection for primary prophylaxis of the gastric variceal hemorrhage.

The study enrolled all adult subjects having elevated-risk gastric varices (size > 10 mm or cherry-red spot) without previous bleeding who underwent endoscopic ultrasound-guided coil and cyanoacrylate injection for primary prevention of gastric variceal bleeding. Post-therapy gastric variceal bleeding was the major endpoint.

The trial included 80 individuals having a mean variceal size of about 22.5±9.4 mm and mean length of follow-up 3.0±2.4 years. Etiology of portal hypertension was noncirrhotic in 9 (11.3%) and cirrhosis in 71 (88.7%). The mean model for end-stage liver disease (MELD) was 12.3±3.7 in cirrhosis subjects. The mean coil number and glue volume injected were 1.5 (range 1-3) and 2 ml (range 0.5-5), respectively.

Technical success was attained in 100%, 96.7% had endoscopic ultrasound confirmation of gastric varices obliteration, and 67.7% were obliterated with the aid of one therapy session. The noxious effects were witnessed in 4 (4.9%) patients while the post-therapy gastric variceal bleeding was noted in 2 (2.5%) patients. No mortality was associated with gastric variceal bleeding and there was no requirement for emergent transjugular intrahepatic shunts during the trial follow-up.

Endoscopic ultrasound-guided coil and cyanoacrylate injection are very effective to prevent gastric variceal bleeding. The prophylaxis of elevated-risk gastric varices with coil and cyanoacrylate glue injection should be taken into consideration in healthcare centers with suitable expertise.