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Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis

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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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Acknowledgements

General support by program director of Gastroenterology Sonu Dhillon M.D. This manuscript was not presented as part at any meeting.

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No financial support in the form of grants or equipment.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA

    Muhammad Baig & Srinivas Reddy Puli

  2. Department of Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India

    Mohan Ramchandani

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  1. Muhammad Baig
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  3. Srinivas Reddy Puli
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Contributions

MB conceived of the study, performed the literature research with data extraction, and helped to draft the manuscript. MB also takes responsibility for the integrity of the work as a whole from inception to published article and is designated as ‘guarantor’. MR assisted with the literature search, data extraction, and helped to draft the manuscript. SP helped with data analysis, provided guidance in drafting the article, and revised it critically.

Corresponding author

Correspondence to Muhammad Baig.

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Conflict of interest

All the authors of this article do not have any conflict of interest with publication of this manuscript or any institution or product that is mentioned in this manuscript and/or is important to the outcome of the study presented. The authors also do not have any conflict of interest with products that compete with those mentioned in this manuscript. None of the authors had any financial relationship within the last 3 years with biotechnology manufacturer, a pharmaceutical company, or other commercial entity that has any interest in the subject matter, materials, or process(es) discussed in the manuscript.

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Study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments.

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This study does not contain identifying information of the patients.

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The manuscript has been read and approved by all the authors and the requirements for authorship have been met. Each author believes that the manuscript represents honest work.

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Baig, M., Ramchandani, M. & Puli, S.R. Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis. Clin J Gastroenterol 15, 310–319 (2022). https://doi.org/10.1007/s12328-022-01600-0

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  • DOI: https://doi.org/10.1007/s12328-022-01600-0

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