Background: Gastric variceal bleeding is a common and serious complication of liver cirrhosis and carries a high mortality. Endoscopic variceal ligation (EVL) is widely used, but its efficacy for gastric varices is limited by incomplete variceal capture and a high rate of post-ligation rebleeding. Objectives: To evaluate the effectiveness and safety of metal clip-assisted endoscopic variceal ligation (MEVL) versus traditional ligation (TL) in adults with cirrhotic gastric varices. Design: Single-center retrospective observational cohort study, reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. Methods: Adults with cirrhosis and gastroesophageal (gastroesophageal varices)-type varices undergoing elective ligation for primary or secondary prophylaxis at Henan Provincial People’s Hospital between May 2019 and December 2023 were included; emergency endoscopies were excluded. Non-selective beta-blocker co-therapy was standardized. Baseline imbalance was addressed by propensity score matching and inverse probability of treatment weighting (IPTW), pre-specified as the primary balancing method. Multivariable logistic regression, Cox proportional hazards modeling, and post hoc power were computed in SPSS 26 and Python 3.11. Results: Ninety-nine patients were analyzed (MEVL n = 46; TL n = 53) with comparable baseline characteristics. One-session eradication was achieved in 33 of 46 MEVL patients (71.7%) compared with 26 of 53 TL patients (49.1%), favoring MEVL after IPTW adjustment (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.03–6.27; p = 0.042) and on Cox regression (adjusted hazard ratio 1.53, 95% CI 1.00–2.35; p = 0.049). Early rebleeding between 120 h and 6 weeks occurred in 0 of 46 MEVL patients versus 5 of 53 TL patients (9.4%; p = 0.059; post hoc power 87%); the adjusted OR for any rebleeding favored MEVL (0.24, 95% CI 0.07–0.82; p = 0.023). All-cause mortality (3/46 vs 6/53) and adverse reactions (11/46 vs 14/53) did not differ. Conclusion: MEVL was associated with higher one-session eradication than TL, with no increase in adverse reactions. A reduction in cumulative rebleeding was suggested by adjusted logistic regression but was not confirmed by time-to-event Cox analysis; this finding should be interpreted as exploratory rather than definitive. Multicenter prospective validation is required. Clinical trial registration: Since this is a retrospective, non-randomized study, it was not registered as a clinical trial.
Wang et al. (Mon,) studied this question.
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