Fei Liu, Zhenyun Gong, Jialiang Huang, Duanmin Hu, Guilian Cheng
EUS-A using cyanoacrylate may be a feasible alternative for select patients with NVUGIB who have failed or are unsuitable for standard therapies, particularly those with malignancy-related bleeding.
BACKGROUND AND STUDY AIMS: Refractory non-variceal upper gastrointestinal bleeding (NVUGIB) remains a clinical challenge. Endoscopic ultrasound-guided angioembolization (EUS-A) may offer a salvage hemostatic approach, but evidence is limited. This study aimed to evaluate the efficacy and safety of EUS-A for management of refractory NVUGIB.
METHODS: Twenty-eight patients with NVUGIB who underwent EUS-A at The Second Affiliated Hospital of Soochow University from January 2023 to December 2025 were enrolled in this study. Endoscopic ultrasound-guided intravascular cyanoacrylate injection was carried out when patients had failed and/or were deemed unsuitable candidates for standard therapies. The data were retrospectively collected.
RESULTS: A total of 28 patients underwent 30 EUS-A procedures. Among these, 8 cases were due to bleeding from benign lesions. The technical success rate was 100% (8/8; 95% CI, 0.63-1), 30-day rebleeding rate was 0% (0/8; 95% CI: 0-0.37), clinical success rate was 100% (8/8; 95% CI: 0.63-1), and bleeding-related mortality rate was 0% (0/8; 95% CI: 0-0.37). The 20 cases were due to bleeding from malignant lesions. The technical success rate was 100% (22/22; 95% CI: 0.85-1), 30-day rebleeding rate was 22.7% (5/22; 95% CI: 0.08-0.45), clinical success rate was 77.3% (17/22; 95% CI: 0.55-0.92), and bleeding-related mortality rate was 15.0% (3/20; 95% CI: 0.03-0.38). The overall technical success rate was 100% (30/30; 95% CI: 0.88-1), 30-day rebleeding rate was 16.7% (5/30; 95% CI: 0.06-0.35), clinical success rate was 83.3% (25/30; 95% CI: 0.65-0.94), and bleeding-related mortality rate was 10.7% (3/28; 95% CI: 0.02-0.28). No procedure-related complications such as perforation or ectopic embolism occurred.
CONCLUSION: EUS-A using cyanoacrylate may be a feasible alternative for select patients with NVUGIB who have failed or are unsuitable for standard therapies, particularly those with malignancy-related bleeding.