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 EU...
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| Veröffentlicht in: | Clinical journal of gastroenterology 2022-04, Vol.15 (2), p.310-319 |
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| creator | Baig, Muhammad Ramchandani, Mohan Puli, Srinivas Reddy |
| description | 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. |
| doi_str_mv | 10.1007/s12328-022-01600-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2626889867</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2626889867</sourcerecordid><originalsourceid>FETCH-LOGICAL-c277t-9257deea81f5cd3be233b991301398daf70fb79064f48317f0c73457be91d6b73</originalsourceid><addsrcrecordid>eNp9UcuO1DAQtBCIfcAPcEA-cjH4MbETbmjFS1qJA3C2HLs9eJXEg9vZVb6CX8azs-yRS3dLXVWtriLkleBvBefmHQqpZM-4lIwLzTnjT8i56HXHjNTd08e5M2fkAvGGcy25Uc_JmeqEUlp25-TPdxehbtQtgUKMyTu_0RwpLCGjz4fk6TrV4jCvS2D7NQUI1Od5TIurKS-0_oLiDhuNudBawNUZlnpU2DuspdFvXauA76mjuGGFufE8LXCb4O7-7AzVMbe4acOEL8iz6CaElw_9kvz89PHH1Rd2_e3z16sP18xLYyob2lMBwPUidj6oEaRS4zAIxYUa-uCi4XE0A9e7uOuVMJF7o3adGWEQQY9GXZI3J91Dyb9XwGrnhB6myS2QV7RSS933Q6-PUHmC-pIRC0R7KGl2ZbOC22MQ9hSEbUHY-yAsb6TXD_rrOEN4pPxzvgHUCYBtteyh2Ju8luYC_k_2LyfXlnQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2626889867</pqid></control><display><type>article</type><title>Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Baig, Muhammad ; Ramchandani, Mohan ; Puli, Srinivas Reddy</creator><creatorcontrib>Baig, Muhammad ; Ramchandani, Mohan ; Puli, Srinivas Reddy</creatorcontrib><description>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.</description><identifier>ISSN: 1865-7257</identifier><identifier>EISSN: 1865-7265</identifier><identifier>DOI: 10.1007/s12328-022-01600-0</identifier><identifier>PMID: 35133625</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Abdominal Surgery ; Colorectal Surgery ; Cyanoacrylates - adverse effects ; Esophageal and Gastric Varices - chemically induced ; Esophageal and Gastric Varices - therapy ; Gastroenterology ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - therapy ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Original Article ; Surgical Oncology ; Treatment Outcome ; Ultrasonography, Interventional</subject><ispartof>Clinical journal of gastroenterology, 2022-04, Vol.15 (2), p.310-319</ispartof><rights>Japanese Society of Gastroenterology 2022</rights><rights>2022. Japanese Society of Gastroenterology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c277t-9257deea81f5cd3be233b991301398daf70fb79064f48317f0c73457be91d6b73</citedby><cites>FETCH-LOGICAL-c277t-9257deea81f5cd3be233b991301398daf70fb79064f48317f0c73457be91d6b73</cites><orcidid>0000-0003-1724-3837</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12328-022-01600-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12328-022-01600-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35133625$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baig, Muhammad</creatorcontrib><creatorcontrib>Ramchandani, Mohan</creatorcontrib><creatorcontrib>Puli, Srinivas Reddy</creatorcontrib><title>Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis</title><title>Clinical journal of gastroenterology</title><addtitle>Clin J Gastroenterol</addtitle><addtitle>Clin J Gastroenterol</addtitle><description>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.</description><subject>Abdominal Surgery</subject><subject>Colorectal Surgery</subject><subject>Cyanoacrylates - adverse effects</subject><subject>Esophageal and Gastric Varices - chemically induced</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Gastroenterology</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><issn>1865-7257</issn><issn>1865-7265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcuO1DAQtBCIfcAPcEA-cjH4MbETbmjFS1qJA3C2HLs9eJXEg9vZVb6CX8azs-yRS3dLXVWtriLkleBvBefmHQqpZM-4lIwLzTnjT8i56HXHjNTd08e5M2fkAvGGcy25Uc_JmeqEUlp25-TPdxehbtQtgUKMyTu_0RwpLCGjz4fk6TrV4jCvS2D7NQUI1Od5TIurKS-0_oLiDhuNudBawNUZlnpU2DuspdFvXauA76mjuGGFufE8LXCb4O7-7AzVMbe4acOEL8iz6CaElw_9kvz89PHH1Rd2_e3z16sP18xLYyob2lMBwPUidj6oEaRS4zAIxYUa-uCi4XE0A9e7uOuVMJF7o3adGWEQQY9GXZI3J91Dyb9XwGrnhB6myS2QV7RSS933Q6-PUHmC-pIRC0R7KGl2ZbOC22MQ9hSEbUHY-yAsb6TXD_rrOEN4pPxzvgHUCYBtteyh2Ju8luYC_k_2LyfXlnQ</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Baig, Muhammad</creator><creator>Ramchandani, Mohan</creator><creator>Puli, Srinivas Reddy</creator><general>Springer Singapore</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1724-3837</orcidid></search><sort><creationdate>20220401</creationdate><title>Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis</title><author>Baig, Muhammad ; Ramchandani, Mohan ; Puli, Srinivas Reddy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c277t-9257deea81f5cd3be233b991301398daf70fb79064f48317f0c73457be91d6b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdominal Surgery</topic><topic>Colorectal Surgery</topic><topic>Cyanoacrylates - adverse effects</topic><topic>Esophageal and Gastric Varices - chemically induced</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Gastroenterology</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baig, Muhammad</creatorcontrib><creatorcontrib>Ramchandani, Mohan</creatorcontrib><creatorcontrib>Puli, Srinivas Reddy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baig, Muhammad</au><au>Ramchandani, Mohan</au><au>Puli, Srinivas Reddy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis</atitle><jtitle>Clinical journal of gastroenterology</jtitle><stitle>Clin J Gastroenterol</stitle><addtitle>Clin J Gastroenterol</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>15</volume><issue>2</issue><spage>310</spage><epage>319</epage><pages>310-319</pages><issn>1865-7257</issn><eissn>1865-7265</eissn><abstract>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.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>35133625</pmid><doi>10.1007/s12328-022-01600-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1724-3837</orcidid></addata></record> |
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| identifier | ISSN: 1865-7257 |
| ispartof | Clinical journal of gastroenterology, 2022-04, Vol.15 (2), p.310-319 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Colorectal Surgery Cyanoacrylates - adverse effects Esophageal and Gastric Varices - chemically induced Esophageal and Gastric Varices - therapy Gastroenterology Gastrointestinal Hemorrhage - chemically induced Gastrointestinal Hemorrhage - therapy Hepatology Humans Medicine Medicine & Public Health Original Article Surgical Oncology Treatment Outcome Ultrasonography, Interventional |
| title | Safety and efficacy of endoscopic ultrasound-guided combination therapy for treatment of gastric varices: a systematic review and meta-analysis |
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