Endoscopic Ultrasound-Guided Coiling Plus Glue Injection Compared With Other Endoscopic Modalities in Managing Gastric Varices: A Systematic Review and Meta-Analysis

Background and Aims: Gastric varices (GV) are a major complication of portal hypertension, with a high risk of severe bleeding. Conventional endoscopic glue injection or endoscopic ultrasound (EUS) directed therapies have been used for treatment. However, each has its limitations. EUS-guided combination of coil and glue injection has emerged as a potential strategy to improve outcomes. This meta-analysis compares the efficacy and safety of EUS-coil and glue to other endoscopic modalities in GV management. Methods: Five databases were systematically searched until October 2024. Data were pooled using risk ratios (RRs) with 95% confidence intervals (CIs) via a random-effect model. Heterogeneity was assessed using the I² statistic, and subgroup and sensitivity analyses were performed. The risk of bias in studies and the certainty of the evidence were evaluated. Results: Nine studies with 579 patients met the inclusion criteria. Compared with other modalities, EUS-coil and glue had a lower risk of reintervention (RR = 0.32, 95% CIs = 0.21–0.50) and a higher rate of GV obliteration (RR = 1.18, 95% CIs = 1.03–1.37). There was no significant difference in mortality risk (RR = 0.87, 95% CIs = 0.54–1.40). The overall risk of adverse events (RR = 0.55, 95% CIs = 0.34–0.90) was lower, particularly rebleeding (RR = 0.36, 95% CIs = 0.22–0.59). The certainty of evidence ranged from very low to moderate due to bias and study heterogeneity. Conclusions: EUS-coil and glue injection offers superior efficacy and a favorable safety profile compared with other endoscopic treatments for GV. However, the quality of the evidence warrants further well-designed studies to assess long-term outcomes.

Journal of Gastroenterology and Hepatology

Journal of Gastroenterology and Hepatology

41

1440-1746

N/A

2

16