Safety and effectiveness of endoscopic ultrasound-guided coil plus glue vs. direct endoscopic glue injection for the treatment of gastric varices: a systematic review and meta-analysis

Background/Aims: Although endoscopic glue injection is the conventional first-line treatment for gastric variceal (GV) bleeding, a large body of evidence supports the safety and effectiveness of endoscopic ultrasound (EUS)-guided coil and glue injections. We compared the safety and efficacy of these two modalities.Methods: A random-effects model was used for the pooled estimates. The outcomes of interest were the odds of technical success, GV obliteration, adverse events, rebleeding, reintervention, and pulmonary embolization (PE).Results: Eight studies involving 659 patients (EUS-guided coil+glue, n=200; endoscopic glue, n=459) were included in the meta-analysis. The rebleeding (odds ratio [OR], 0.28, 95% confidence interval [CI], 0.16–0.51; I2=0%) and reintervention (OR, 0.28; 95% CI, 0.15–0.52; I2=0%) rates were significantly lower in the EUS-guided coil+glue. EUS-guided coil+glue group had higher rates (OR, 4.56; 95% CI, 2.04 –10.19; I2=30%) of GV obliteration after the first session. No difference in the odds of technical success (OR, 2.03; 95% CI, 0.50–8.22; I2=0%), adverse events (OR, 1.19; 95% CI, 0.44–3.20; I2=45%), abdominal pain (OR, 1.17; 95% CI, 0.36–3.82; I2=44%) fever (OR, 1.09; 95% CI, 0.41–2.92; I2=0%), PE (OR, 0.52; 95% CI, 0.19–1.47; I2=0%) and all-cause mortality (OR, 0.67; 95% CI, 0.32–1.40; I2=0%) was identified.Conclusions: EUS-guided coil and glue injections are safe and effective for the treatment of gastric varices.