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

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

doi:10.1097/eus.0000000000000017

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

Endosc Ultrasound. 2023 Jul-Aug;12(4):351-361. doi: 10.1097/eus.0000000000000017. Epub 2023 Sep 13.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA.
² Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
³ Division of Gastroenterology, Emory University, Atlanta, GA, USA.
⁴ Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁵ MNGI Digestive Health, MN, USA.
⁶ Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.
⁷ Department of Gastroenterology, University of California San Francisco (UCSF), San Francisco, CA, USA.
⁸ Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN, USA.
⁹ Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA.

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.

Keywords: EUS; Gastric varices; Variceal hemorrhage.