Endoscopic Ultrasound-Guided Coiling plus Glue Injection Compared with Endoscopic Glue Injection Alone in Endoscopic Treatment for Gastric Varices: A Systematic Review and Meta-Analysis

Cynthia Florencio de Mesquita; Vanio Antunes; Natalia Junkes Milioli; Matheus Vanzin Fernandes; Tulio L Correa; Otávio Cosendey Martins; Radhika Chavan; Stefano Baraldo

doi:10.1016/j.gie.2024.10.005

Endoscopic Ultrasound-Guided Coiling plus Glue Injection Compared with Endoscopic Glue Injection Alone in Endoscopic Treatment for Gastric Varices: A Systematic Review and Meta-Analysis

Gastrointest Endosc. 2024 Oct 8:S0016-5107(24)03551-X. doi: 10.1016/j.gie.2024.10.005. Online ahead of print.

Authors

Cynthia Florencio de Mesquita¹, Vanio Antunes², Natalia Junkes Milioli³, Matheus Vanzin Fernandes², Tulio L Correa⁴, Otávio Cosendey Martins⁵, Radhika Chavan⁶, Stefano Baraldo⁷

Affiliations

¹ Federal University of Pernambuco, Center for Medical Sciences, Brazil. Electronic address: cynthia.florencio@ufpe.br.
² Federal University of Health Sciences of Porto Alegre, Brazil.
³ Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
⁴ Beth Israel Deaconess Medical Center, United States.
⁵ Federal University of Juiz de Fora, Brazil.
⁶ Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Gujarat, India.
⁷ Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil.

PMID: 39389435
DOI: 10.1016/j.gie.2024.10.005

Abstract

Background and aims: Endoscopic ultrasound (EUS) guided coil plus glue injection has emerged as a safe and effective modality for gastric varices (GV). Very few studies have compared EUS embolization with direct endoscopic glue injection (EGI) technique for its safety and effectiveness. In this systematic review and meta-analysis, we aim to compare the outcomes of EUS-guided coil plus glue injection versus EGI.

Methods: Medline, Embase, and Cochrane databases were searched for studies that compared EUS and EGI for GV. A total of 1,454 articles were screened following the PRISMA protocol. Endpoints were pulmonary embolism, rebleeding rate, reintervention rate, technical success, abdominal pain, and mortality rate. A restricted maximum likelihood random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was employed for binary endpoints. Heterogeneity was evaluated through Cochrane's Q statistic and Higgins and Thompson's I² statistic. Significance was defined as a p-value < 0.05.

Results: We included six studies with a total of 445 patients treated for gastric varices. The mean age of patients was 49 years, and 43% were female. EUS was associated with a reduction in rebleeding rate (OR 0.22; 95% CI 0.11 to 0.45; p<0.001; I²=0) and in reintervention rates (OR 0.29; 95% CI 0.09 to 0.89; p=0.03; I²=49%) compared with EGI. There were no differences between groups in pulmonary embolism (OR 0.34; 95% CI 0.10 to 1.18; p=0.09; I²=0%), mortality rate (OR 0.78; 95% CI 0.28 to 2.13; p=0.63; I²=0%), technical success (OR 3.50; 95% CI 0.60 to 20.49; p=0.16; I²=0%), fever (OR 1.49 days; 95% CI 0.42 to 5.21 days; p=0.5; I²=0%), and abdominal pain (OR 0.96; 95% CI 0.31 to 2.95; p=0.94; I²=32%).

Conclusion: In patients with gastric varices, EUS-guided coil plus glue injection is associated with lower rebleeding and reintervention rate than EGI with no difference in pulmonary embolization rate, reintervention, abdominal pain, technical success, and mortality rate.

Publication types

Review