LAUSR

BACKGROUND AND AIMS Gastric variceal bleeding (GVB) is associated with high morbidity and mortality. Endoscopic ultrasound (EUS) guided coil and cyanoacrylate (CYA) injection (EUS-CCI) has been shown to be an effective therapy in acute bleeding and secondary prophylaxis; however, there is a paucity of data on primary prophylaxis. METHODS Single center observational study of adult patients with high-risk GV (size > 10 mm or cherry red spot) without prior bleeding who underwent EUS-CCI for the primary prophylaxis of GVB between June 2009 and December 2019. The primary outcome was post-treatment GVB. RESULTS Eighty patients with a mean variceal size of 22.5±9.4 mm and mean length of follow-up 3.0±2.4 years were included. The etiology of portal hypertension was cirrhosis in 71 (88.7%) and noncirrhotic in 9 (11.3). The mean MELD was 12.3±3.7 in patients with cirrhosis. Mean coil number and glue volume injected were 1.5 (range 1-3) and 2 mL (range 0.5-5), respectively. Technical success was achieved in 100%, 96.7% had EUS confirmation of GV obliteration, and 67.7% were obliterated with 1 treatment session. Post-treatment GVB occurred in 2 (2.5%) patients, and adverse events occurred in 4 (4.9%) patients. There were no deaths related to GVB and no need for emergent transjugular intrahepatic shunts during the follow-up period. CONCLUSIONS In patients with high-risk GV, EUS-CCI for primary prophylaxis is highly effective at preventing GVB with a low rate of adverse events. Primary prophylaxis of high-risk GV with coil and CYA glue injection should be considered in centers with the appropriate expertise.