P0731 - EUS-Guided Coil Plus Cyanoacrylate vs Conventional Endoscopic Cyanoacrylate Alone in the Treatment of Gastric Varices: A Systematic Review and Meta-Analysis

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Muhammad Hayat, MD¹, Marjan Haider, MD², Manesh Kumar Gangwani, MD³, Muhammad Aziz, MD⁴, Umar Hayat, MD⁵, Christian Salcedo, MD⁶, Umer Farooq, MD⁷, Nasir Saleem, MD⁸, Sachit Sharma, MD⁹, Muhammad Khan, MD¹⁰, Faisal Kamal, MD^11
1Vanderbilt University Medical Center, Nashville, TN; ²Trinity Health Ann Arbor Hospital, Ann Arbor, MI; ³University of Toledo, Toledo, OH; ⁴Bon Secours Mercy, Toledo, OH; ⁵Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁶University of Tennessee Health Science Center, Memphis, TN; ⁷SSM Health Saint Louis University Hospital, St. Louis, MO; ⁸Indiana University School of Medicine, Indianapolis, IN; ⁹Virginia Commonwealth University Medical Center, Richmond, VA; ¹⁰MD Anderson Cancer Center, Houston, TX; ¹¹Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

Introduction: Gastric variceal bleeding is conventionally managed with endoscopic cyanoacrylate (CYA) glue injection. Lately, endoscopic ultrasound (EUS)-guided coil embolization plus CYA have been used in the management of gastric varices with favorable results. Studies have compared EUS-guided coil embolization plus CYA injection with direct endoscopic CYA injection. We conducted a systematic review and meta-analysis comparing these two modalities in the management of gastric varices.

Methods: Several databases were reviewed to identify studies comparing outcomes of EUS Coil plus CYA and endoscopic CYA alone in patients with gastric varices including PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews from inception until June 10, 2024. Our outcomes of interest were technical success, obliteration of gastric varices, early rebleeding, overall adverse events, and pulmonary embolism. We calculated risk ratios (RRs), and their corresponding 95% confidence intervals (CIs) for all dichotomous variables. Data was analyzed using random-effect model. Heterogeneity was assessed using the I² statistic.

Results: Six studies comprising 409 patients (EUS Coil plus CYA 137 and endoscopic CYA alone 272) met the inclusion criteria. We found no significant difference in rate of technical success between groups, RR (95% CI): 1.01 (0.98, 1.04), p=0.57 (Figure 1A). There was no significant difference in other outcomes between groups including obliteration of gastric varices; RR (95% CI): 1.20 (0.89, 1.62), p=0.23, Overall adverse events; RR (95% CI): 0.65 (0.26, 1.66), p=0.37, Pulmonary embolism; RR (95% CI): 0.50 (0.21, 1.18), p=0.11. The EUS Coil plus CYA was associated with lower rates of early rebleeding as compared to endoscopic CYA alone, RR (95% CI): 0.40 (0.22, 0.74), p=0.03 (Figure 1B).

Discussion: Our meta-analysis found no significant difference in most of the outcomes in patients with gastric varices treated with EUS Coil plus CYA vs endoscopic CYA alone except rate of early rebleeding was significantly lower in EUS Coil plus CYA group.



Disclosures:


Aamir Saeed, MD¹, Saira Yousuf, MD¹, Muhammad Hayat, MD¹, Marjan Haider, MD², Manesh Kumar Gangwani, MD³, Muhammad Aziz, MD⁴, Umar Hayat, MD⁵, Christian Salcedo, MD⁶, Umer Farooq, MD⁷, Nasir Saleem, MD⁸, Sachit Sharma, MD⁹, Muhammad Khan, MD¹⁰, Faisal Kamal, MD¹¹. P0731 - EUS-Guided Coil Plus Cyanoacrylate vs Conventional Endoscopic Cyanoacrylate Alone in the Treatment of Gastric Varices: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.