Comparative efficacy and safety of endoscopic treatments for gastric varices: a systematic review and network meta-analysis.
Mattia Brigida, Stefano Francesco Crinò, Abdulrahman Alfadda et al.
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In 30 seconds
This systematic review and network meta-analysis evaluated the efficacy and safety of various endoscopic treatments for gastric varices in 760 patients across 10 randomized controlled trials. EUS-guided cyanoacrylate injection and EUS-guided coil+cyanoacrylate injection demonstrated significantly lower rebleeding rates compared to direct endoscopic cyanoacrylate injection, with risk ratios of 0.39 and 0.15, respectively.
Key findings
- EUS-guided cyanoacrylate injection reduced rebleeding rates (RR 0.39, 95%CI 0.27-0.58) compared to direct endoscopic cyanoacrylate injection.
- EUS-guided coil+cyanoacrylate injection showed even lower rebleeding rates (RR 0.15, 95%CI 0.03-0.90).
- EUS-guided cyanoacrylate injection had a lower adverse event rate (RR 0.59, 95%CI 0.48-0.72) than endoscopic cyanoacrylate injection.
- Large-volume band ligation and thrombin injection also had lower adverse event rates compared to endoscopic cyanoacrylate injection.
Why it matters
Understanding the comparative efficacy and safety of endoscopic treatments for gastric varices is crucial for optimizing patient management and reducing complications associated with rebleeding.
What to keep in mind
The quality of evidence was very low, indicating a need for further randomized controlled trials to confirm findings.