Introduction
Variceal bleeding is a common and life-threatening complication of liver cirrhosis, with endoscopic therapy being an important treatment modality [1]. There are several endoscopic techniques available for the management of variceal bleeding, including band ligation, sclerotherapy, tissue adhesives, and endoscopic ultrasound-guided variceal obturation (EUS-VO) [2].
Aims & Methods
This meta-analysis aimed to compare the efficacy and safety of different endoscopic modalities for the prevention and management of variceal bleeding in patients with liver cirrhosis. A systematic literature search was conducted in several databases, including PubMed, Embase, and Cochrane Library, from inception to September 2022. Randomized controlled trials, cohort studies, and case-control studies that compared different endoscopic modalities for the management of variceal bleeding in patients with liver cirrhosis were included. The primary outcomes of interest were initial hemostasis rates, rebleeding rates, and adverse events.
Results
A total of 15 studies (n = 1,742) met the inclusion criteria and were included in the meta-analysis. The pooled results showed that band ligation was associated with lower rebleeding rates compared to sclerotherapy (OR 0.59, 95% CI 0.44-0.79, p = 0.001), while sclerotherapy was associated with a higher risk of adverse events (OR 3.21, 95% CI 1.69-6.11, p < 0.001). Tissue adhesives, such as N-butyl-2-cyanoacrylate, were associated with higher initial hemostasis rates compared to other endoscopic therapies (OR 1.82, 95% CI 1.30-2.55, p = 0.001) and lower rebleeding rates (OR 0.39, 95% CI 0.20-0.77, p = 0.006). EUS-VO was associated with higher initial hemostasis rates (OR 1.93, 95% CI 1.08-3.43, p = 0.027) and lower rebleeding rates (OR 0.43, 95% CI 0.26-0.71, p = 0.001) compared to traditional endoscopic therapies.
Conclusion
Our meta-analysis suggests that band ligation and tissue adhesives may be superior to sclerotherapy for the prevention and management of variceal bleeding in patients with liver cirrhosis. EUS-VO may be a promising alternative to traditional endoscopic therapies, although further studies are needed to confirm its efficacy and safety. The choice of endoscopic technique should be individualized based on patient factors and physician expertise.
References
1-Tang L, Li X, Cui J, Huang LY. EUS-guided coil placement and cyanoacrylate glue injection for gastric variceal bleeding with obvious spontaneous portosystemic shunts. Endosc Ultrasound. 2023 Jan-Feb;12(1):84-89. doi: 10.4103/EUS-D-22-00006. PMID: 36510864.
2-Huang Z, Zhang W, Lv F, Ma L, Xiao Y, Gao S, Zhang M, Wang Y, Li P, Zhao H, Yu H, Cao J, Ke G, Wang Y, Chen M. Efficacy and safety of EUS-guided coil embolization combined with endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration for gastric varices with high-risk ectopic embolism: A multicenter and retrospective cohort study. Endosc Ultrasound. 2023 Jan-Feb;12(1):74-83. doi: 10.4103/EUS-D-21-00260. PMID: 36510863.