Endoscopic Ultrasound-Guided Coiling Plus Glue Injection Compared With Other Endoscopic Modalities in Managing...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Hepatology

Background:

• Gastric varices (GV) are a serious complication of portal hypertension, associated with a high risk of bleeding.
• Current endoscopic treatments like glue injection and endoscopic ultrasound (EUS)-directed therapies have limitations.
• EUS-guided coil and glue injection presents a promising alternative for managing GV.

Purpose of the Study:

• To compare the efficacy and safety of EUS-guided coil and glue injection with other endoscopic modalities for gastric varices management.
• To evaluate outcomes such as reintervention rates, GV obliteration, mortality, and adverse events.

Main Methods:

• A systematic literature search was conducted across five databases up to October 2024.
• A random-effect model was used to pool data, calculating risk ratios (RRs) with 95% confidence intervals (CIs).
• Risk of bias and certainty of evidence were assessed, with subgroup and sensitivity analyses performed.

Main Results:

• Nine studies involving 579 patients were analyzed.
• EUS-coil and glue demonstrated a lower reintervention risk (RR=0.32) and higher GV obliteration rates (RR=1.18).
• The treatment showed a lower overall risk of adverse events (RR=0.55), including reduced rebleeding (RR=0.36), with no significant difference in mortality.

Conclusions:

• EUS-guided coil and glue injection is superior in efficacy and safety for treating gastric varices compared to other endoscopic methods.
• The current evidence, though promising, has limitations in quality and certainty.
• Further well-designed studies are needed to confirm long-term outcomes and solidify evidence.