Reply to Dr. Lo

Abstract

We appreciate the comments from Dr. Lo. Uncontrolled gastric variceal hemorrhage has a 20 % mortality rate. Endoscopic cyanoacrylate injection is the standard of care; however, 35 % of patients will rebleed within 2 years, with a 6.8 %-12.5 % bleeding-related death rate [1]. Additionally, there are nonfatal and fatal reported adverse events in up to 13 %-20 % of patients [1]. In our study, we found that 2 /5 patients in both the endoscopic ultrasonography (EUS)-guided therapy groups died from bleeding gastric varices, with a 6.6 % rate of mortality related to gastric variceal bleeding [2]. A significant difference in terms of recurrence, rebleeding, and the need for reintervention in favor of EUS-guided combined therapy was observed. However, there was no difference in terms of overall (30 % versus 26 %) or bleeding-related mortality (17 % for both techniques). We did not record any procedure-related fatal adverse events. We agree with Dr. Lo on the importance of techniques that decrease the mortality related to bleeding gastric varices, and these should be compared in larger multicenter randomized trials. Recently, a meta-analysis including all EUS modalities for the management of gastric varices found that these had a significantly superior obliteration rate in comparison to endoscopic glue injection