Abstract
Background
EUS-guided combination therapy (coil and hemostatic glue) for bleeding and non-bleeding gastric varices has recently attracted considerable attention after promising results were published in multiple small studies. We performed a meta-analysis to investigate the safety and efficacy of EUS-guided combination therapy in the treatment of GVs.
Methods
Publications investigating the safety and efficacy of EUS-guided combination therapy in patients with gastric varices were searched in Medline, Ovid Journals, Medline non-indexed citations and Cochrane Central Register of Controlled Trials. Pooling was conducted by both fixed and random effects model.
Results
In pooled analysis of 10 studies (N = 323), the technical success of EUS-guided combination therapy was 98.66% (95% CI 97.14–99.62). The pooled variceal obliteration rate after first session of treatment was 78.31% (95% CI 73.05–83.14). In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.79% (95% CI 94.28–98.60). The pooled rate of hemorrhage from treated gastric varices was 4.92% (95% CI 2.85–7.52). After EUS-guided combination therapy, the pooled percentage of patients develo** abdominal pain was 9.79% (95% CI 6.82–13.24), pulmonary embolism was 2.20% (95% CI 0.89–4.06), febrile episodes was 1.17% (95% CI 0.30–2.61), and procedure-related bleeding was noted in 2.62% (95% CI 1.18–4.63) of the patients. Subgroup analysis of studies using coil embolization and cyanoacrylate injection showed pooled variceal obliteration rate of 77.92% (95% CI 72.35–83.01) after first session of treatment. In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.76% (95% CI 94.11–98.65). The pooled rate of re-bleeding from treated gastric varices was 5.09% (95% CI 2.90–7.83).
Conclusions
This meta-analysis suggests that EUS-guided combination therapy is safe and effective for patients with gastric varices and should be considered in the clinical management of these patients.
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General support by program director of Gastroenterology Sonu Dhillon M.D. This manuscript was not presented as part at any meeting.
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MB conceived of the study, performed the literature research with data extraction, and helped to draft the manuscript. MB also takes responsibility for the integrity of the work as a whole from inception to published article and is designated as ‘guarantor’. MR assisted with the literature search, data extraction, and helped to draft the manuscript. SP helped with data analysis, provided guidance in drafting the article, and revised it critically.
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Baig, M., Ramchandani, M. & Puli, S.R. Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis. Clin J Gastroenterol 15, 310–319 (2022). https://doi.org/10.1007/s12328-022-01600-0
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DOI: https://doi.org/10.1007/s12328-022-01600-0