EUS-Guided Therapy May Reduce Rebleeding From Gastric Varices: Endoscopy | September 2026

Introduction:

The optimal endoscopic treatment for gastric varices remains uncertain. Conventional direct cyanoacrylate injection is widely used, while EUS-guided glue and coil-based therapies allow more targeted variceal treatment. This network meta-analysis compared currently available endoscopic approaches.

Why was this study needed?

Gastric variceal bleeding carries substantial mortality and rebleeding risk.

Several endoscopic techniques are available without a clearly established hierarchy.

Direct head-to-head randomized comparisons remain limited.

EUS-guided therapy may improve targeting while reducing glue-related complications.

Key Findings:

10 RCTs involving 760 patients were included.

EUS-guided cyanoacrylate reduced rebleeding versus conventional cyanoacrylate injection (RR 0.39).

EUS-guided coil + cyanoacrylate showed an even larger reduction in rebleeding (RR 0.15).

No technique demonstrated clear superiority for complete variceal obliteration.

EUS-guided cyanoacrylate had fewer adverse events than conventional glue injection (RR 0.59).

Large-volume band ligation and thrombin also showed fewer adverse events than conventional cyanoacrylate.

Overall certainty of evidence was very low, limiting definitive treatment ranking.

Bottom Line:

EUS-guided cyanoacrylate—with or without coils—appears to reduce gastric-variceal rebleeding compared with conventional glue injection. The signal favors EUS-guided therapy, but stronger head-to-head RCTs are needed before declaring a definitive standard.