EUS-Guided Coil + Cyanoacrylate vs TIPS for Gastric Variceal Bleeding: Endoscopy | August 2026

Introduction:

Gastric variceal bleeding (GVB) is a high-risk portal hypertensive emergency in which conventional endoscopic therapy may be inadequate. EUS-guided coil embolisation plus cyanoacrylate (EUS-Coils+CYA) offers targeted variceal obliteration, whereas TIPS plus variceal embolisation (TIPS+VE) reduces portal pressure while directly treating the varix. This multicenter study compared these two approaches.

Why was this study needed?

Both EUS-guided therapy and TIPS are increasingly used for GVB.

Direct comparative evidence remains limited.

Treatment selection must balance bleeding control against complications such as hepatic encephalopathy (HE) and embolisation.

Identifying patients better suited to each strategy could personalise GVB management.

Results:

After propensity matching, 124 patients were analyzed; technical success was 100% with both strategies.

Rebleeding was similar with EUS-Coils+CYA and TIPS+VE (11.3% vs 9.7%), with no significant mortality difference.

HE was substantially lower with EUS-Coils+CYA (1.6% vs 14.5%), while TIPS+VE also caused more postprocedural abdominal pain.

Conversely, EUS-Coils+CYA carried a 9.7% risk of ectopic embolization, all pulmonary embolic events, versus none with TIPS+VE.

Clinical Impact:

The study suggests there may be no universally superior intervention for gastric variceal bleeding. EUS-guided therapy provides comparable bleeding control without creating a portosystemic shunt and may therefore be attractive when HE is a major concern. TIPS remains particularly relevant when portal decompression itself is required, but its encephalopathy burden must be considered.

Importantly, the pulmonary embolization signal with EUS-Coils+CYA emphasizes the need for meticulous technique and careful control of cyanoacrylate delivery.

Bottom Line:

EUS-guided coil plus cyanoacrylate and TIPS plus variceal embolization achieved similar rebleeding and survival outcomes in gastric variceal bleeding—but with different complication profiles: EUS therapy produced far less hepatic encephalopathy, whereas TIPS avoided the ectopic embolization seen with cyanoacrylate. Treatment should therefore be individualized according to portal-hypertension physiology, HE risk, anatomy, and local expertise.