Clipping before ECI lowers risk of ectopic embolisms in gastric varices

Adding clip prior to endoscopic cyanoacrylate injection (ECI) helps prevent ectopic embolism in patients with fundal varices with a portal-systemic shunt, without compromising safety or efficacy, as shown in a recent study.

This multicentre, open-label, parallel, randomized controlled trial included patients with fundal gastric varices and gastrorenal shunts from 10 tertiary hospitals. Eligible participants were randomly allocated to clip-assisted ECI (Clip-ECI, n=35) or conventional ECI groups (Con-ECI, n=35).

The occurrence of ectopic embolism was the primary outcome. The investigators performed computed tomography within 48 h of the clinical injection to screen for cyanoacrylate (marked with lipiodol) migration.

Both arms achieved a 100-percent technical success. The Clip-ECI group showed a markedly lower incidence of cyanoacrylate embolism than the Con-ECI group (11.4 percent vs 42.9 percent; p=0.003).

Four patients in the Con-ECI group had symptomatic pulmonary embolism, of which one died. On the other hand, none of those in the Clip-ECI group experienced symptomatic embolism (11.4 percent vs 0 percent; p=0.114). Moreover, clip-related bleeding did not occur in any of the groups.

No significant between-group differences were noted in total rebleeding rate (14.3 percent vs 14.3 percent) and survival rate (97.1 percent vs 93.9 percent) over a median follow-up of 10.1 and 9.9 months, respectively.

“Ectopic embolism caused by cyanoacrylate migration is a severe complication,” the investigators said.