The evidence for optimal endoscopic management of
bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing
cyanoacrylate injection and band
ligation. To help guide endoscopic decisions regarding acute gastric variceal
bleeding, a meta-analysis was conducted.Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active
bleeding control,
blood transfusion, rebleeding, recurrence of
varices, complications, and survival.Three RCTs were identified, which included 194 patients with active gastric variceal
bleeding from Taiwan and Romania. Active
bleeding control was achieved in 46 of 49 (93.9%) patients in the
cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band
ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal
varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but
cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal
varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated
gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015).
Cyanoacrylate injection was also superior in controlling recurrence of
gastric varices to band
ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included.Compared with band
ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal
bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed.