Safety and effectiveness of endoscopic ultrasound-guided coil plus glue vs. direct endoscopic glue injection for the treatment of gastric varices: a systematic review and meta-analysis.

IF 3.4 Q3 GASTROENTEROLOGY & HEPATOLOGY

Clinical Endoscopy Pub Date : 2026-09-01 Epub Date: 2026-09-28 DOI:10.5946/ce.2025.251

Zahid Ijaz Tarar, Mustafa Gandhi, Umer Farooq, Gopala K Konduri, Ahmad Zain, Zohaib Ahmed, Baltej Singh, Ryan J Law, Nirav Thosani

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Abstract

Background: Although endoscopic glue injection is the conventional first-line treatment for gastric variceal (GV) bleeding, a large body of evidence supports the safety and effectiveness of endoscopic ultrasound (EUS)-guided coil and glue injections. We compared the safety and efficacy of these two modalities.

Methods: A random-effects model was used for the pooled estimates. The outcomes of interest were the odds of technical success, GV obliteration, adverse events, rebleeding, reintervention, and pulmonary embolization (PE).

Results: Eight studies involving 659 patients (EUS-guided coil+glue, n=200; endoscopic glue, n=459) were included in the meta-analysis. The rebleeding (odds ratio [OR], 0.28, 95% confidence interval [CI], 0.16-0.51; I2=0%) and reintervention (OR, 0.28; 95% CI, 0.15-0.52; I2=0%) rates were significantly lower in the EUS-guided coil+glue. EUS-guided coil+glue group had higher rates (OR, 4.56; 95% CI, 2.04 -10.19; I2=30%) of GV obliteration after the first session. No difference in the odds of technical success (OR, 2.03; 95% CI, 0.50-8.22; I2=0%), adverse events (OR, 1.19; 95% CI, 0.44-3.20; I2=45%), abdominal pain (OR, 1.17; 95% CI, 0.36-3.82; I2=44%) fever (OR, 1.09; 95% CI, 0.41-2.92; I2=0%), PE (OR, 0.52; 95% CI, 0.19-1.47; I2=0%) and all-cause mortality (OR, 0.67; 95% CI, 0.32-1.40; I2=0%) was identified.

Conclusions: EUS-guided coil and glue injections are safe and effective for the treatment of gastric varices.

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内镜下超声引导线圈加胶与内镜下直接注射胶治疗胃静脉曲张的安全性和有效性：一项系统综述和荟萃分析。

背景：虽然内镜下注射胶是胃静脉曲张（GV）出血的常规一线治疗方法，但大量证据支持内镜下超声（EUS）引导下线圈和胶注射的安全性和有效性。我们比较了这两种方式的安全性和有效性。方法：采用随机效应模型进行汇总估计。关注的结果是技术成功的几率、GV闭塞、不良事件、再出血、再干预和肺栓塞（PE）。结果：8项研究纳入659例患者（eus引导线圈+胶水，n=200；内镜胶水，n=459）。再出血（优势比[OR]， 0.28, 95%可信区间[CI]， 0.16-0.51; I2=0%）和再干预（OR, 0.28; 95% CI, 0.15-0.52; I2=0%）率在eus引导下的线圈+胶水中显著降低。eus引导下线圈+胶水组在第一次治疗后GV闭塞率较高（OR, 4.56; 95% CI, 2.04 -10.19; I2=30%）。技术成功（OR, 2.03; 95% CI, 0.50-8.22; I2=0%）、不良事件（OR, 1.19; 95% CI, 0.44-3.20; I2=45%）、腹痛（OR, 1.17; 95% CI, 0.36-3.82; I2=44%）、发热（OR, 1.09; 95% CI, 0.41-2.92; I2=0%）、PE （OR, 0.52; 95% CI, 0.19-1.47; I2=0%）和全因死亡率（OR, 0.67; 95% CI, 0.32-1.40; I2=0%）的几率均无差异。结论：eus引导下线圈和胶注射治疗胃静脉曲张安全有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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