EUS-guided therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis.

IF 4.4 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Endoscopic Ultrasound Pub Date : 2023-07-01 Epub Date: 2023-09-13 DOI:10.1097/eus.0000000000000017

Saurabh Chandan, Andrew Khoi Nguyen, Babu P Mohan, Smit Deliwala, Daryl Ramai, Lena L Kassab, Arunkumar Muthusamy, Antonio Facciorusso, Faisal Kamal, Mohammad Bilal, Jayanta Samanta, Douglas G Adler

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引用次数: 0

Abstract

Background and objectives: Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding.

Methods: We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I² % statistics.

Results: Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; I² = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; I² = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; I² = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; I² = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; I² = 0), 95.5% (CI, 80.3%-99.1%; I² = 0), and 88.7% (CI, 76%-95.1%; I² = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; I² = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; I² = 31), 92.3% (CI, 81.1%-97.1%; I² = 0), and 84.5% (CI, 50.8%-96.7%; I² = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; I² = 16) and 20.6% (CI, 9.3%-39.5%; I² = 66), respectively.

Conclusion: Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.

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EUS指导的胃静脉曲张一级和二级预防治疗的最新系统综述和荟萃分析。

背景和目的：与食道静脉曲张相比，胃静脉曲张（GVs）与不受控制的出血和死亡的风险更高。虽然内镜注胶治疗传统上用于GV的二级预防，但有关一级预防的数据仍在不断出现。最近，EUS引导的治疗方法已被用于GV出血。方法：从成立到2022年6月，我们对几个主要数据库进行了全面搜索。我们的主要目标是评估一级和二级预防中EUS指导治疗的疗效、GV闭塞、GV复发和再出血的合并率。评估了总体不良事件和技术故障。随机效应模型用于我们的荟萃分析，异质性使用I2%统计进行评估。结果：纳入了18项研究，共604名患者。在一级预防中，GV闭塞的合并率为90.2%（置信区间[CI]，81.1-95.2；I2=0）。EUS胶卷联合治疗，有效率为95.4%（CI，86.7%-98.5%；I2=0）。治疗后GV出血的合并率为4.9%（CI，1.8%-12.4%；I2=0）。在二级预防中，综合治疗有效率为91.9%（CI，86.8%-95.2%；I2=12）。使用EUS胶、EUS线圈以及EUS胶和线圈的组合，其发生率分别为94.3%（CI，88.9%-97.1%；I2=0）、95.5%（CI，80.3%-99.1%；I2=0%）和88.7%（CI，76%-95.1%；I2=14）。GV闭塞的合并率为83.6%（CI，71.5%-91.2%；I2=74）。使用EUS胶、EUS线圈以及EUS胶和线圈的组合，其发生率分别为84.6%（CI，75.9%-90.6%；I2=31）、92.3%（CI，81.1%-97.1%；I2=0）和84.5%（CI，50.8%-96.7%；I2=75）。GV再出血和复发的合并率分别为18.1%（CI，13.1%-24.3%；I2=16）和20.6%（CI：9.3%-39.5%；I2=66）。结论：我们的分析表明，EUS引导的GVs治疗在技术上是可行的，并且在GV的一级和二级预防中都是成功的。

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来源期刊

Endoscopic Ultrasound GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.20

自引率

11.10%

发文量

144

期刊介绍： Endoscopic Ultrasound, a publication of Euro-EUS Scientific Committee, Asia-Pacific EUS Task Force and Latin American Chapter of EUS, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal’s full text is available online at http://www.eusjournal.com. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal does not charge for submission, processing or publication of manuscripts and even for color reproduction of photographs.