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.