PMID- 37886793
OWN - NLM
STAT- Publisher
LR  - 20231120
IS  - 1443-1661 (Electronic)
IS  - 0915-5635 (Linking)
DP  - 2023 Oct 27
TI  - Comparison of endoscopic ultrasound-guided primary and secondary prophylaxis for 
      gastric variceal bleeding.
LID - 10.1111/den.14713 [doi]
AB  - OBJECTIVES: Endoscopic ultrasound (EUS)-guided injection of cyanoacrylate (CYA) 
      for primary prophylaxis (PP) of gastric varices (GV) is controversial. This study 
      evaluates the safety and efficacy of this intervention. METHODS: Patients treated 
      for PP of GV bleeding by EUS injection of CYA with or without coils were 
      identified. Endoscopic techniques, outcomes, and adverse events (AEs) were 
      reviewed and compared with a group treated for secondary prophylaxis (SP). 
      Patients were followed until: (i) loss to follow-up; (ii) GV bleeding; (iii) 
      interventional radiology or surgery decompression; (iv) liver transplant; or (v) 
      death or comfort care. RESULTS: One hundred and nineteen patients (61 men; mean 
      59 +/- 12 years) underwent EUS for PP (n = 24) or SP (n = 95). The PP group was 
      treated with CYA alone (n = 18) or with coils (n = 4). Eight (33%) mild (n = 6) 
      or moderate (n = 2) AEs and no index GV bleeding occurred during a mean of 
      6.1 +/- 5.9 months follow-up. Repeat EUS in 22 (92%) PP patients showed 7 (32%) 
      residual GVs, which were retreated with CYA alone (n = 6) or with coils (n = 1). 
      Two (29%) mild (n = 1) or moderate (n = 1) AEs occurred after repeat EUS and 1/22 
      (5%) index GV bleed occurred during a mean 23 +/- 25 months follow-up. Compared to 
      the SP group, the PP group had lower Model for End-stage Liver Disease (MELD) 
      score (P = 0.03), fewer GV stigmata (P < 0.001), required less CYA (P = 0.019) 
      during index EUS, and had a longer time between index and surveillance EUS 
      (P = 0.014). The incidence of AEs and GV bleeding between the two groups were 
      similar. CONCLUSION: Posttreatment GV bleeding and AEs are similar following 
      EUS-guided primary and secondary GV prophylaxis.
CI  - (c) 2023 Japan Gastroenterological Endoscopy Society.
FAU - Sarkis, Yara
AU  - Sarkis Y
AUID- ORCID: 0000-0002-8548-8572
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Masuoka, Howard
AU  - Masuoka H
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Ghabril, Marwan
AU  - Ghabril M
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Gutta, Aditya
AU  - Gutta A
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Al-Haddad, Mohammad A
AU  - Al-Haddad MA
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Stainko, Sarah
AU  - Stainko S
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Cohen, Lainna
AU  - Cohen L
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
FAU - Perkins, Anthony
AU  - Perkins A
AD  - Department of Biostatistics and Health Data Science, Indiana University Health 
      Medical Center, Indianapolis, USA.
FAU - DeWitt, John M
AU  - DeWitt JM
AD  - Department of Gastroenterology and Hepatology, Indiana University Health Medical 
      Center, Indianapolis, USA.
LA  - eng
PT  - Journal Article
DEP - 20231027
PL  - Australia
TA  - Dig Endosc
JT  - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy 
      Society
JID - 9101419
SB  - IM
OTO - NOTNLM
OT  - coils
OT  - cyanoacrylate
OT  - endoscopic ultrasound
OT  - gastric varices
OT  - primary prophylaxis
EDAT- 2023/10/27 06:42
MHDA- 2023/10/27 06:42
CRDT- 2023/10/27 04:52
PHST- 2023/08/22 00:00 [received]
PHST- 2023/10/24 00:00 [accepted]
PHST- 2023/10/27 06:42 [pubmed]
PHST- 2023/10/27 06:42 [medline]
PHST- 2023/10/27 04:52 [entrez]
AID - 10.1111/den.14713 [doi]
PST - aheadofprint
SO  - Dig Endosc. 2023 Oct 27. doi: 10.1111/den.14713.