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Background <p>Bleeding from gastric varices (GVs) is a severe complication of portal hypertension. Conventional endoscopic cyanoacrylate injection (Con-ECI) is an effective treatment, but it is associated with significant risks of rebleeding and systemic ectopic embolism. Clip-assisted ECI (Clip-ECI), where clips are deployed before glue injection, has been developed to mitigate these risks, but its efficacy remains debatable.</p> Methods <p>A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted for studies up to August 2025. The primary outcomes were all-cause rebleeding and ectopic embolism. Secondary outcomes included variceal obliteration, mortality, and procedure-related complications. Risk ratios (RR) with 95% confidence intervals (CI) were pooled from randomized and non-randomized studies using a random-effects model. PROSPERO ID: <Emphasis Type="Underline">CRD420251163015</Emphasis>.</p> Results <p>Seven studies involving 783 patients were included. Compared to Con-ECI, Clip-ECI was associated with a significantly lower risk of variceal rebleeding (RR: 0.24; 95% CI [0.12, 0.48]; P &lt; 0.001) and ectopic embolism (RR: 0.31; 95% CI [0.13, 0.76]; P = 0.01). The pooled rates of variceal rebleeding and ectopic embolism in the Clip-ECI group were 7.1% and 2.1%, respectively. Also, Clip-ECI achieved a significantly higher rate of complete variceal obliteration (RR: 1.39; 95% CI [1.23, 1.57]; P &lt; 0.001). There were no significant differences in all-cause mortality (P = 0.28), technical success (P = 0.35), or other adverse events.</p> Conclusion <p>In patients with GVs, Clip-ECI significantly reduces the risks of rebleeding and ectopic embolism while improving variceal obliteration, without increasing adverse events, compared with Con-ECI.</p>

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FIGThe Efficacy and Safety of Clip-Assisted Endoscopic Cyanoacrylate Injection for Gastric Varices: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Mohamed Abuelazm,
  • Yousef Hawas,
  • Belal Mohamed Hamed,
  • Abdelrahman Awad,
  • EzzElDien A. Ibrahim,
  • Hatem Eltaly,
  • Mohamed Nasser Elshabrawi,
  • Ibrahim Gowaily,
  • Mohamed Elgendy,
  • Douglas G. Adler

摘要

Background

Bleeding from gastric varices (GVs) is a severe complication of portal hypertension. Conventional endoscopic cyanoacrylate injection (Con-ECI) is an effective treatment, but it is associated with significant risks of rebleeding and systemic ectopic embolism. Clip-assisted ECI (Clip-ECI), where clips are deployed before glue injection, has been developed to mitigate these risks, but its efficacy remains debatable.

Methods

A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted for studies up to August 2025. The primary outcomes were all-cause rebleeding and ectopic embolism. Secondary outcomes included variceal obliteration, mortality, and procedure-related complications. Risk ratios (RR) with 95% confidence intervals (CI) were pooled from randomized and non-randomized studies using a random-effects model. PROSPERO ID: CRD420251163015.

Results

Seven studies involving 783 patients were included. Compared to Con-ECI, Clip-ECI was associated with a significantly lower risk of variceal rebleeding (RR: 0.24; 95% CI [0.12, 0.48]; P < 0.001) and ectopic embolism (RR: 0.31; 95% CI [0.13, 0.76]; P = 0.01). The pooled rates of variceal rebleeding and ectopic embolism in the Clip-ECI group were 7.1% and 2.1%, respectively. Also, Clip-ECI achieved a significantly higher rate of complete variceal obliteration (RR: 1.39; 95% CI [1.23, 1.57]; P < 0.001). There were no significant differences in all-cause mortality (P = 0.28), technical success (P = 0.35), or other adverse events.

Conclusion

In patients with GVs, Clip-ECI significantly reduces the risks of rebleeding and ectopic embolism while improving variceal obliteration, without increasing adverse events, compared with Con-ECI.