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CC BY 4.0 · Endosc Int Open 2025; 13: a25491165
DOI: 10.1055/a-2549-1165
Original article

Endoscopic ultrasound-guided therapies versus retrograde transvenous obliteration for gastric varices: Multicenter propensity matched analysis

Authors

  • Suprabhat Giri  ‡

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Ranjan Kumar Patel‡

    2   Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India (Ringgold ID: RIN410775)

  • Radhika Chavan 

    3   Gastroenterology, Ansh Clinic, Ahmedabad, India (Ringgold ID: RIN609456)

  • Bhavik Bharat Shah 

    4   Department of Gastroenterology, Shree Narayana Hospital, Raipur, India (Ringgold ID: RIN706422)
    5   Department of Gastroenterology, MediGenix Hospital, Raipur, India

  • Jimmy Narayan

    6   Department of Gastroenterology, SOA IMS and SUM Hospital, Bhubaneswar, India (Ringgold ID: RIN250350)

  • Taraprasad Tripathy

    2   Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India (Ringgold ID: RIN410775)

  • Sushant Babbar

    7   Department of Interventional Radiology, Dayanand Medical College and Hospital, Ludhiana, India (Ringgold ID: RIN29761)

  • Lalit Garg

    8   Department of Interventional Radiology, Santokba Durlabhji Memorial Hospital, Jaipur, India (Ringgold ID: RIN29783)

  • Rozil Gandhi

    9   Department of Interventional Radiology, Sushrut Hospital, Ahmedabad, India

  • Karan Manoj Anandpara

    10   Department of Interventional Radiology, Heart & Vascular Superspecialty Hospitals, India, India

  • Swati Das

    11   Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Manjit Kanungo

    6   Department of Gastroenterology, SOA IMS and SUM Hospital, Bhubaneswar, India (Ringgold ID: RIN250350)

  • Girish Kumar Pati

    6   Department of Gastroenterology, SOA IMS and SUM Hospital, Bhubaneswar, India (Ringgold ID: RIN250350)

  • Hemanta K Nayak

    12   Department of Gastroenterology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India (Ringgold ID: RIN410775)

  • Manas Kumar Panigrahi 

    12   Department of Gastroenterology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India (Ringgold ID: RIN410775)

  • Preetam Nath

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Saroj Kanta Sahu

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Dibya Lochan Praharaj

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Bipadabhanjan Mallick

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Sarat Chandra Panigrahi

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Sanjay Rajput

    13   Department of Gastroenterology, Ansh Clinic, Ahmedabad, India (Ringgold ID: RIN609456)

  • Jimil Shah

    14   Gastroenterology, PGIMER, Chandigarh, India (Ringgold ID: RIN29751)

  • Anil Chandra Anand

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)

  • Manoj Kumar Sahu

    1   Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India (Ringgold ID: RIN90946)
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Abstract

Background and study aims

Retrograde transvenous obliteration (RTO) is an established technique for managing fundal varices. Endoscopic ultrasound (EUS)-guided glue injection with or without coil is an alternate approach. The present study compared outcomes of EUS-guided therapies with RTO for managing fundal varices.

Patients and methods

We retrospectively analyzed data from patients with fundal varices undergoing EUS-guided intervention or RTO at 10 tertiary centers in India and compared after propensity score matching. The primary outcome was variceal bleeding within 1 year. Secondary outcomes included procedure-related adverse events (AEs), variceal obliteration, reintervention, and mortality.

Results

A total of 167 patients (EUS 108, RTO 59) were included, with 59 in each group after propensity score matching. Incidence of variceal bleeding (15.3% vs. 13.6%, P = 0.793) within 1 year was comparable between the groups. Procedure-related AEs were higher in the RTO group (22% vs. 5.1%, P = 0.007), primarily new onset or worsening of ascites. Variceal obliteration at 4 weeks was similar between groups (83.1% vs. 91.5%, P = 0.167). Although reintervention within 1 year of the index procedure (30.5% vs. 22.0%, P = 0.296) was comparable, the EUS group required more frequent reintervention for GVs (28.8% vs. 5.1%, P = 0.001), and the RTO group required more frequent reintervention for EVs (16.9% vs. 1.7%, P = 0.008).

Conclusions

EUS-guided therapy offers a safe and effective alternative to RTO for managing fundal varices. Although reintervention rate for GVs were higher than for EUS, incidence of AEs and reintervention for EVs was higher with RTO.

Keywords

Endoscopic ultrasonography - Intervention EUS - GI radiology


Publication History

Received: 11 December 2024

Accepted after revision: 27 February 2025

Accepted Manuscript online:
28 February 2025

Article published online:
04 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Suprabhat Giri, Ranjan Kumar Patel, Radhika Chavan, Bhavik Bharat Shah, Jimmy Narayan, Taraprasad Tripathy, Sushant Babbar, Lalit Garg, Rozil Gandhi, Karan Manoj Anandpara, Swati Das, Manjit Kanungo, Girish Kumar Pati, Hemanta K Nayak, Manas Kumar Panigrahi, Preetam Nath, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Sarat Chandra Panigrahi, Sanjay Rajput, Jimil Shah, Anil Chandra Anand, Manoj Kumar Sahu. Endoscopic ultrasound-guided therapies versus retrograde transvenous obliteration for gastric varices: Multicenter propensity matched analysis. Endosc Int Open 2025; 13: a25491165.
DOI: 10.1055/a-2549-1165
 

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