Gastric varices (GVs) are less prevalent than esophageal varices (EVs), developing in 17%–25% of patients with portal hypertension, irrespective of cirrhosis; conversely, EVs develop in up to 85% of these patients [1], [2], [3]. Although EVs are more common and associated with bleeding more frequently, gastric variceal bleeding is more severe, with a higher mortality and risk of rebleeding [1], [2], [3], [4], [5]. Evidence supporting recommendations for the management of GVs is considerably less robust than for that of EVs [3]. There is a consensus that type I gastroesophageal varices (GOV-I)—commonly referred to as junctional varices—should be managed similar to EVs; however, the optimal approach for the management of cardiofundal varices (GOV-II and isolated GVs [IGV-] I), which are more difficult to control while bleeding and have a higher risk of recurrence and mortality than GOV-I, is unclear [3], [6], [7].

Since its introduction, endoscopic injection of cyanoacrylate (EI-CYA) has been used as an initial—and often definitive—treatment for acute hemorrhage, and as secondary prophylaxis for GVs, achieving hemostasis rates of 80%–90% and low rates of rebleeding. However, drawbacks include endoscopic characterization of GVs and high rates of embolic events [4], [8], [9]. Endoscopic ultrasound-guided CYA injection (EUS-CYA) into the varix has been pursued with the aim of improving the precision and safety of EI-CYA by visualizing the gastric wall and associated vasculature, even during active bleeding; conducting real-time assessment with Doppler imaging (DI); and reducing embolization risk by minimizing the amount of CYA injected [10]. EUS monitoring to determine variceal obliteration was previously associated with lower recurrent bleeding rates and improved survival [11]; however, EUS-CYA has also been associated with systemic embolization [12], [13]. In 2008, the effectiveness of EUS-guided coil deployment (EUS-coil) was first reported in a patient with refractory bleeding from anastomotic varices [14]. Subsequently, EUS-coil was used—either alone or with CYA injection (EUS-coil/CYA)—with the intention that the coil would increase primary hemostasis while minimizing distal systemic embolization [15], [16]. Despite the promising prospect of coil deployment for the treatment of GVs, the benefit of EUS-coil/CYA over EUS-coil therapy has not yet been clarified. Therefore, the aim of this study was to compare the results of EUS-coil and EUS-coil/CYA for the management of cardiofundal GVs.