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

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.