P2783 - Comparative Effectiveness and Safety of Endoscopic Ultrasound-Guided Therapy versus Direct Endoscopic Glue Injection Therapy for Gastric Varices: A Systematic Review and Meta-Analysis

Azizullah Beran, MD¹, Mouhand F.H. Mohamed, MD, MSc², Hazem Abosheaishaa, MD³, Hala Fatima, MD⁴, Mark A. Gromski, MD¹, Mohammad Al-Haddad, MD, FACG¹, John M. DeWitt, MD, FACG¹, Jeffrey Easler, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Mayo Clinic, Rochester, MN; ³Icahn School of Medicine at Mount Sinai, Queens, NY; ⁴Indiana University, Indianapolis, IN

Introduction: Gastric variceal (GV) bleeding can be treated with either direct endoscopic cyanoacrylate (CYA) glue injection therapy (DEG-T) and endoscopic ultrasound (EUS)-guided therapies (EUS-T), including CYA glue injection and/or coil embolization. The current data on the outcomes of EUS-T and DEG-T is largely based on a meta-analysis using indirect evidence from non-comparative studies. To provide more reliable insights, we conducted a meta-analysis of studies that directly compared EUS-T with DEG-T.

Methods: We searched PubMed, Embase, and Web of Science databases to include all comparative studies that assessed the outcomes of EUS-T with DEG-T for GV bleeding. Single-arm studies were excluded. Pooled mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CIs) were obtained within a random-effect model.

Results: Eight studies (six observational studies and two randomized controlled trials [RCT]) with 592 patients with GV (n=257 EUS-T vs. n=335 DEG-T) were included. EUS-T was associated with lower rebleeding (RR 0.35, 95% CI 0.24-0.51, p< 0.001), lower reintervention (RR 0.23, 95% CI 0.12-0.44, p< 0.001), and lower volume of CYA (MD -1.47 mL; 95% CI -2.51, -0.43; p=0.006) than DEG-T (Figure 1). Subgroup analysis for rebleeding based on the type of EUS-T showed consistent results favoring EUS-T over DEG-T regardless of whether patients received CYA injection (RR 0.37, 95% CI 0.21-0.67), coil embolization (RR 0.36, 95% CI 0.17-0.76) or combined CYA injection and coil embolization (RR 0.32, 95% CI 0.17-0.62) (Figure 1). There was a trend toward fewer treatment sessions (MD -0.32; 95% CI -0.67, 0.03; p=0.07), fewer overall complications (RR 0.53, 95% CI 0.24-1.17, p=0.12), and lower rates of pulmonary embolism (RR 0.54, 95% CI 0.23-1.27, p=0.16) with EUS-T compared to DEG-T but did not reach statistical significance. There was no significant difference in technical success (RR 1.03, 95% CI 0.93-1.14, p=0.57) and all-cause mortality (RR 0.93, 95% CI 0.23-3.73, p=0.92) between the two groups.

Discussion: EUS-guided therapy technique for GV bleeding was associated with lower rates of rebleeding and reintervention and comparable rates of complications compared to direct endoscopic glue injection. Moreover, EUS-guided therapy required a lower volume of CYA injection. Our data suggests an EUS-guided technique is a more effective option for treating GV bleeding. More RCTs are needed to evaluate the interval benefit of an EUS-guided approach.



Disclosures:


Azizullah Beran, MD¹, Mouhand F.H. Mohamed, MD, MSc², Hazem Abosheaishaa, MD³, Hala Fatima, MD⁴, Mark A. Gromski, MD¹, Mohammad Al-Haddad, MD, FACG¹, John M. DeWitt, MD, FACG¹, Jeffrey Easler, MD¹. P2783 - Comparative Effectiveness and Safety of Endoscopic Ultrasound-Guided Therapy versus Direct Endoscopic Glue Injection Therapy for Gastric Varices: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.