EUS-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 L J Antunes; Natalia Junkes Milioli; Matheus Vanzin Fernandes; Tulio L Correa; Otavio Cosendey Martins; Radhika Chavan; Stefano Baraldo

doi:10.1016/j.gie.2024.10.005

EUS-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 9:S0016-5107(24)03551-X. doi: 10.1016/j.gie.2024.10.005. Online ahead of print.

Authors

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

Affiliations

¹ Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil.
² Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
³ Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵ Federal University of Juiz de Fora, 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: EUS-guided coil plus glue injection has emerged as a safe and effective modality for gastric varices (GVs). Very few studies have compared EUS embolization with the direct endoscopic glue injection (EGI) technique for its safety and effectiveness. In this systematic review and meta-analysis, we compared 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 GVs, and 1454 articles were screened following the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Endpoints were pulmonary embolism, recurrent bleeding rate, reintervention rate, technical success, abdominal pain, and mortality rate. A restricted maximum likelihood random-effects model with odds ratios (ORs) and 95% confidence intervals (CIs) was used for binary endpoints. Heterogeneity was evaluated through Cochrane's Q statistic and Higgins and Thompson's I² statistic. Significance was defined as P < .05.

Results: We included 6 studies with 445 patients treated for GVs. Mean patient age was 49 years, and 43% were women. EUS was associated with a reduction in recurrent bleeding rate (OR, .22; 95% CI, .11-.45; P < .001; I² = 0) and reintervention rate (OR, .29; 95% CI, .09-.89; P = .03; I² = 49%) compared with EGI. There were no differences between groups in pulmonary embolism (OR, .34; 95% CI, .10-1.18; P = .09; I² = 0%), mortality rate (OR, .78; 95% CI, .28-2.13; P = .63; I² = 0%), technical success (OR, 3.50; 95% CI, .60-20.49; P = .16; I² = 0%), fever (OR, 1.49; 95% CI, .42-5.21 days; P = .5; I² = 0%), and abdominal pain (OR, .96; 95% CI, .31-2.95; P = .94; I² = 32%).

Conclusions: In patients with GVs, EUS-guided coil plus glue injection is associated with lower recurrent bleeding and reintervention rates than EGI with no difference in pulmonary embolization rate, abdominal pain, technical success, and mortality rate.

Publication types

Review