{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:11:23Z","timestamp":1791882683292,"version":"4.3.4"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:00:00Z","timestamp":1669075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Endoscopic injection of gastric varices (GVs) using cyanoacrylate (CYA) is associated with significant adverse events (AEs). We aimed to compare the efficacy and safety of endoscopic ultrasound (EUS)-guided CYA injection into the perforating vein versus direct endoscopic injection (DEI) of CYA in treatment of high-risk GVs.<\/jats:p><jats:p>\n          Patients and methods\u2002This was a randomized controlled trial that included 52 patients with high-risk GVs. Group A underwent EUS-guided injection into the perforator vein and Group B underwent DEI of 1\u200amL CYA. Endoscopic examination and Doppler EUS were repeated after 3 months to confirm eradication. Obliteration by Doppler EUS was considered by absence of Doppler flow within the varix. Repeated injection was performed in the absence of obliteration. Doppler EUS examination was repeated at 3 and 6 months after each injection.<\/jats:p><jats:p>\n          Results\u2002Forty-three patients including 27 males and 16 females with mean age 57 years completed the study. Variceal obliteration was achieved during the index session after 3 months in eight of 21 (38.1\u200a%) in group B compared to 17 of 22 (77.2\u200a%) in group A (P\u200a=\u200a0.014). There was a significant difference in the amount of CYA needed to achieve obliteration in group B compared to group A (2 vs.1\u200amL, P\u200a=\u200a0.027). There was no statistically significant difference in the overall AE rate between group A and group B (4.5\u200a% vs. 14.3\u200a%, P\u200a=\u200a0.345).<\/jats:p><jats:p>\n          Conclusions\u2002EUS-guided CYA injection into the perforating veins achieved less amount of CYA, fewer number of sessions to obliteration, and similar overall AE rates in the treatment of high-risk GVs compared to DEI.<\/jats:p>","DOI":"10.1055\/a-1984-7070","type":"journal-article","created":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T23:44:48Z","timestamp":1669160688000},"page":"E202-E210","source":"Crossref","is-referenced-by-count":29,"title":["EUS-guided cyanoacrylate injection into the perforating vein versus direct endoscopic injection in the treatment of gastric varices"],"prefix":"10.1055","volume":"11","author":[{"given":"Fady","family":"Sabry","sequence":"additional","affiliation":[{"name":"Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seham","family":"Seif","sequence":"additional","affiliation":[{"name":"Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Eldesoky","sequence":"additional","affiliation":[{"name":"Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Hakim","sequence":"additional","affiliation":[{"name":"Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Youssef","family":"Altonbary","sequence":"additional","affiliation":[{"name":"Mansoura University Faculty of Medicine, Department of Gastroenterology and Hepatology, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.3390\/medicina55070335","article-title":"Current approaches to the treatment of gastric varices: glue, coil application, TIPS, and BRTO","volume":"55","author":"V Goral","year":"2019","journal-title":"Medicina"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1001\/jamasurg.2019.0407","article-title":"Management options for gastric variceal hemorrhage","volume":"154","author":"E W Lee","year":"2019","journal-title":"JAMA Surg"},{"key":"ref3","first-page":"1244","article-title":"Gastric varices: profile, classification, and management","volume":"84","author":"S Sarin","year":"1989","journal-title":"Am J Gastroenterol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"729","DOI":"10.4240\/wjgs.v8.i11.729","article-title":"Pitfalls in histoacryl glue 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S Hall","year":"2017","journal-title":"Clin Endosc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11894-020-00801-2","article-title":"The role of endoscopic ultrasound (EUS) in the management of gastric varices","volume":"23","author":"S S Thiruvengadam","year":"2021","journal-title":"Curr Gastroenterol Rep"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"218","DOI":"10.4103\/2303-9027.187840","article-title":"Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices","volume":"5","author":"A J Wang","year":"2016","journal-title":"Endosc Ultrasound"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.gie.2007.03.008","article-title":"EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases","volume":"66","author":"R Romero-Castro","year":"2007","journal-title":"Gastrointest 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Bick","year":"2019","journal-title":"Surg Endosc"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e5647","DOI":"10.1097\/MD.0000000000005647","article-title":"Incidence of HCV induced-esophageal varices in Egypt: valuable knowledge using data mining analysis","volume":"96","author":"M Abdel-Aty","year":"2017","journal-title":"Medicine"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1055\/a-1123-9054","article-title":"Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial","volume":"52","author":"C Robles-Medranda","year":"2020","journal-title":"Endoscopy"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.cgh.2010.05.019","article-title":"Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate","volume":"8","author":"L F Cheng","year":"2010","journal-title":"Clin Gastroenterol 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