EUS-guided coiling plus glue injection compared with endoscopic glue injection alone in endoscopic treatment for gastric varices: a systematic review and meta-analysis

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-02-01 DOI:10.1016/j.gie.2024.10.005

Cynthia Florencio de Mesquita , Vanio L.J. Antunes , Natalia Junkes Milioli MD , Matheus Vanzin Fernandes MD , Tulio L. Correa MD , Otavio Cosendey Martins , Radhika Chavan MD, DNB, FISG, FASGE , Stefano Baraldo MD

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引用次数: 0

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.

Abstract Image

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在内镜下治疗胃静脉曲张中，内镜超声引导卷曲加胶水注射与单纯内镜胶水注射相比：系统回顾与元分析》。

背景和目的：内镜超声（EUS）引导下的线圈加胶水注射已成为治疗胃静脉曲张（GV）的一种安全有效的方法。很少有研究对 EUS 栓塞与直接内镜胶水注射（EGI）技术的安全性和有效性进行比较。在本系统综述和荟萃分析中，我们旨在比较 EUS 引导下线圈加胶水注射与 EGI 的疗效：方法：我们在 Medline、Embase 和 Cochrane 数据库中检索了比较 EUS 和 EGI 治疗龙胆紫的研究。按照 PRISMA 协议共筛选了 1,454 篇文章。研究终点为肺栓塞、再出血率、再介入率、技术成功率、腹痛和死亡率。对二元终点采用了限制性最大似然随机效应模型，该模型具有几率比（OR）和95%置信区间（CI）。异质性通过 Cochrane 的 Q 统计量以及 Higgins 和 Thompson 的 I2 统计量进行评估。显著性定义为 p 值小于 0.05：我们纳入了六项研究，共有 445 名胃底静脉曲张患者接受了治疗。患者的平均年龄为 49 岁，43% 为女性。与 EGI 相比，EUS 可降低再出血率（OR 0.22；95% CI 0.11 至 0.45；P2=0）和再介入率（OR 0.29；95% CI 0.09 至 0.89；P=0.03；I2=49%）。在肺栓塞（OR 0.34；95% CI 0.10 至 1.18；P=0.09；I2=0%）、死亡率（OR 0.78；95% CI 0.28 至 2.13；P=0.63；I2=0%）、技术成功率（OR 3.50；95% CI 0.60至20.49；P=0.16；I2=0%）、发热（OR 1.49天；95% CI 0.42至5.21天；P=0.5；I2=0%）和腹痛（OR 0.96；95% CI 0.31至2.95；P=0.94；I2=32%）.结论：在胃静脉曲张患者中，EUS引导下线圈加胶水注射的再出血率和再介入率低于EGI，但肺栓塞率、再介入率、腹痛、技术成功率和死亡率无差异。

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.