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 developing 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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Authors | Muhammad Baig, Mohan Ramchandani, Srinivas Reddy Puli |
Journal | Clinical journal of gastroenterology
(Clin J Gastroenterol)
Vol. 15
Issue 2
Pg. 310-319
(Apr 2022)
ISSN: 1865-7265 [Electronic] Japan |
PMID | 35133625
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
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Copyright | © 2022. Japanese Society of Gastroenterology. |
Chemical References |
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Topics |
- Cyanoacrylates
(adverse effects)
- Esophageal and Gastric Varices
(chemically induced, therapy)
- Gastrointestinal Hemorrhage
(chemically induced, therapy)
- Humans
- Treatment Outcome
- Ultrasonography, Interventional
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