Clip-first emergency hemostasis for acute esophagogastric variceal bleeding: a retrospective comparative study
In brief
Clip-first endoscopy used 0.8 mL less glue and 4.1 mL less sclerosant
In a single-center retrospective comparison of 115 bleeding episodes, clip-first treatment was linked to lower use of cyanoacrylate and lauromacrogol, but adjusted hemostasis time was not significantly shorter. Technical success was achieved in every episode, with no major complications or deaths recorded among patients with documented status; larger randomized trials are needed to establish clinical benefit and safety.
- Journal
- Surgical endoscopy (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yurong Cui, Jinxin Li, Bing Zhao, Mengqiang Cai, Kanglin Wu, Wei Liu, et al.
- PMID
- 42823548
- DOI
- 10.1007/s00464-026-13406-z
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 4 October 2026): High-quality evidence in a top journal
- Picked for Gastroenterology (top studies of the week, 4 October 2026): Ranked by evidence level and journal quartile
- Picked for Pediatric Surgery (top studies of the week, 4 October 2026): High-quality evidence in a top journal
- Picked for Surgery (top studies of the week, 4 October 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Active esophagogastric variceal bleeding can obscure the endoscopic field and make definitive therapy difficult during emergency gastroscopy. We evaluated a clip-first strategy designed to obtain immediate mechanical control before local cyanoacrylate reinforcement or staged secondary prophylaxis. METHODS: We retrospectively analyzed 115 acute bleeding episodes among 102 adults treated at a single tertiary center. Episodes were assigned to a clip-first group (n = 42) or a conventional emergency endoscopic therapy group without clip-first control (n = 73). Variceal anatomy was reclassified as esophageal varices (EV) only or by the Sarin system for gastric varices. Primary outcomes were technical success and endoscopic hemostasis time; secondary outcomes included injection material use, rebleeding, adverse events, length of stay, and mortality. RESULTS: Technical success was achieved in all episodes. Hemostasis time was shorter in the unadjusted analysis (10.60 ± 5.14 vs. 12.84 ± 6.66 min; P = 0.049), but the adjusted difference was not statistically significant (- 1.96 min, 95% confidence interval [CI] -4.17 to 0.25; P = 0.081). Adjusted reductions in cyanoacrylate (- 0.79 mL, 95% CI -1.15 to -0.44; P < 0.001) and lauromacrogol (- 4.10 mL, 95% CI -6.82 to -1.37; P = 0.004) remained significant. No perforation, ectopic embolism, local tissue necrosis, or death was recorded among patients with documented status. CONCLUSIONS: Clip-first emergency hemostasis was feasible, with no significant difference in adjusted hemostasis time and with reduced cyanoacrylate and lauromacrogol use. Larger prospective randomized controlled trials are needed to clarify the clinical significance of this strategy, including its effects on hemostatic efficiency, and rebleeding.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.