الفهرس 
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Abstract
Direct endoscopic injection of gastric varices using cyanoacrylate is associated with significant adverse events. Targeting the perforating vessel by EUS rather than the varix lumen may theoretically minimize the amount of CYA and thereby reduce complications. Aim of the Work : To compare the efficacy and safety of EUS-guided CYA injection into the perforating vein versus DEI of CYA in treatment of high-risk GVs. Research Plan : A single center randomized controlled trial that included 52 patients with high-risk GVs > 20 mm. Eligible patients were randomized in two groups : group A underwent EUS-guided injection of 1ml CYA into the perforator vein and group B underwent DEI of 1 ml CYA. Endoscopic examination and doppler EUS were repeated after 3 months to confirm eradication. Repeated injection was performed in the absence of obliteration. Doppler EUS examination was repeated at 3 and 6 months after each injection. Results : Throughout 3 years study period, 43 patients including 27 males and 16 females with mean age 57 ± 7.9 years completed the study and 9 patients lost to follow-up. The mean variceal size was 36.6 ± 10.5 mm in group A and 32.1 ± 8.0 mm in group B. Variceal obliteration was achieved during the index session after 3 months in 8/21 (38.1%) in group B compared to 17/22 (77.2%) in group A (p=0.014). There was significant difference in the amount of CYA needed to achieve obliteration in group B compared to group A (2 vs.1 ml, p=0.027). Overall adverse events rate was more in group B than group A (71.4% vs. 9%, p<0.001). Conclusion : EUS-guided CYA injection into the perforating veins achieved excellent technical success with less amount of CYA, fewer number of sessions to obliteration, and fewer complications rate in the treatment of high-risk GVs compared to DEI.