Combined endoscopic ultrasound and conventional endoscopy improves outcomes in bleeding GOV2 and IGV1 gastric varices: A multicenter retrospective propensity-matched cohort study.

BACKGROUND: Endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices (GVs) may leave residual untreated vessels due to incomplete visualization of distal collateral channels. Whether adding conventional endoscopic injection improves outcomes remains unclear. OBJECTIVES: This multicenter retrospective study evaluated a combined EUS-guided and conventional endoscopic approach in patients with bleeding GOV2 or IGV1 varices. DESIGN: This retrospective study (February 2022-December 2024) included 141 cirrhotic patients with acute gastric variceal bleeding from three Chinese tertiary centers. METHODS: Patients received either EUS-guided therapy alone or combined therapy with supplementary conventional endoscopic injection per institutional practice. Propensity score matching (1:1) and multivariable Cox regression were used to reduce selection bias. Primary outcome was variceal rebleeding; secondary outcomes included technical success, variceal recurrence, reintervention, mortality, and adverse events. RESULTS: Technical success was achieved in all patients (100%). After matching, variceal recurrence rates were comparable between groups (5.36% vs. 12.50%, P = 0.185), whereas rebleeding occurred less frequently in the combination group than in the EUS group (7.14% vs. 25.00%, P = 0.010). This association appeared more pronounced in IGV1 varices (2.70% vs. 27.03%, P = 0.016), although the subgroup finding should be interpreted cautiously because the interaction test was not statistically significant. Reintervention was also less frequent in the combination group (12.50% vs. 35.71%, P = 0.004). Mortality and adverse event rates were comparable between groups. CONCLUSION: Supplementary conventional endoscopic injection after EUS-guided therapy was associated with lower risks of rebleeding and reintervention without an apparent increase in adverse events. This combineds strategy may be a feasible option to improve treatment durability in selected patients with high-risk GOV2 or IGV1 gastric varices, but prospective randomized studies are needed for confirmation.