The efficacy and safety of endoscopic ultrasound selective variceal devascularization for the treatment of esophagogastric varices: a retrospective cohort study

Gastroesophageal variceal bleeding is a life-threatening complication of portal hypertension. This study evaluated the efficacy and safety of endoscopic ultrasound-guided selective variceal devascularization (EUS-SVD) compared with conventional endoscopic cyanoacrylate injection. This retrospective cohort study adhered to the STROBE guidelines. Between August 2022 and June 2024, 107 patients were enrolled and allocated to conventional endoscopy ( n = 52) or EUS-SVD ( n = 55). Propensity score matching was performed to reduce confounding. Primary outcomes included rebleeding, ulcer formation, and resource utilization. Compared with the conventional group, the EUS group required significantly lower volumes of polidocanol and cyanoacrylate (both P < 0.05). The 6‑month rebleeding rate and 3‑month ulcer formation rate were significantly lower in the EUS group ( P < 0.05). Kaplan-Meier analysis demonstrated a reduced cumulative rebleeding incidence in the EUS group (HR 0.38, 95%CI 0.17–0.86, P = 0.021). Within the limitations of a single-center retrospective design, these findings suggest that EUS-SVD may represent a promising therapeutic option for gastroesophageal varices, although it requires validation in prospective randomized trials.