To evaluate real-world outcomes and key quality indicators of cyanoacrylate injection for gastric varices in a tertiary hepatology–endoscopy unit, and to benchmark performance against international standards for portal hypertensive bleeding

We conducted a prospective single-centre audit of consecutive patients undergoing cyanoacrylate glue injection for gastric varices between April 2025 and August 2025. Data collected using a standardised proforma included demographics, Child–Pugh class, indication, varix type, operator level, glue volume, adjunctive pharmacotherapy (antibiotics, vasoactive drugs, carvedilol), technical success, intraprocedural complications, early (≤5 days) and 6-week rebleeding, 6-week mortality, and follow-up endoscopy findings. Results are descriptive

Seventeen patients (median age 61 years; IQR 57–67; 13/17 male) were included. Most had decompensated cirrhosis: Child–Pugh A/B/C in 29%, 53% and 18% respectively. Indications were prophylactic treatment in 13/17 (76%) and active bleeding in 4/17 (24%). Varix types included GOV2 (47%), IGV1 (29%), GOV1 (18%) and IGV2 (6%). Management reflected real-world practice patterns in our unit, including selected use of cyanoacrylate for high-risk GOV1 lesions when band ligation was not feasible.

Median glue volume was 2 mL (IQR 1–3). Procedures were performed by consultants in 82% and by Senior registrars in 18%. Carvedilol was used in 65% and antibiotics in 69% of cases. Vasoactive drugs were appropriately administered only in patients with active bleeding. Immediate technical success was achieved in 15/17 (88%). Intraprocedural complications occurred in 4/17 (24%): bleeding in 3 patients, controlled endoscopically, and mild pain in 1; no embolic events were observed.

Early (≤5 days) rebleeding occurred in 19% (3/16) with available data, and 6-week rebleeding in 17% (2/12). Six-week mortality was 19% (3/16), all in Child–Pugh C patients. Follow-up endoscopy was planned in 71% and completed in 3 to date, all showing residual varices requiring further therapy. Key quality indicators (technical success, safety, rebleeding) align with expected ranges for a predominantly Child–Pugh B/C population.

Cyanoacrylate injection for gastric varices demonstrated high technical success and an acceptable safety profile in this real-world cohort, with no embolic complications. Rebleeding and mortality reflected underlying disease severity. These findings highlight opportunities to strengthen adjunctive therapy consistency and structured follow-up endoscopy. Ongoing audit cycles will support benchmarking against ESGE and Baveno VII quality standards.