P4481 - An Updated Systematic Review and Meta-Analysis Comparing the Efficacy of EUS-Guided Coiling vs Cyanoacrylate Injection for Gastric Varices

Hasan Al-Obaidi, MD¹, Omar Saab, MD², Ali Wakil, MD³, Nooraldin Merza, MD⁴, Mustafa Al-Obaidi, MD⁵, Pratiksha Moliya, MD⁶, Hussein Harb, MS⁷, Iya Agha, MS⁸, Sana Rabeeah, MD⁹, Abdallah Kobeissy, MD^4
1Jamaica Hospital Medical Center, Briarwood, NY; ²Cleveland Clinic, Westlake, OH; ³Brooklyn Hospital Center, Brooklyn, NY; ⁴University of Toledo College Medicine and Life Sciences, Toledo, OH; ⁵Lund University, Malmö, Skane Lan, Sweden; ⁶Jamaica Hospital Medical Center, Edison, NJ; ⁷Ross University School of Medicine, Miramar, FL; ⁸New York Institute of Technology College of Osteopathic Medicine, New York, NY; ⁹University of Toledo, Toledo, OH

Introduction: Gastric varices (GV) are enlarged veins in the esophagus and stomach caused by portal hypertension and are a major cause of upper gastrointestinal bleeding. GV is common among patients with liver cirrhosis, affecting approximately 20% of cirrhotic patients. The incidence of bleeding has been reported in approximately 25% of GV patients. The re-bleeding rates have been recorded as high as 40%, with mortality rate estimates of up to 50%. Endoscopic ultrasound interventions are the superior choice for treating bleeding GV in emergencies. EUS-guided coil application is a promising but costly method for improving outcomes.

Methods: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 16th February 2024. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in Odds ratio (OR) with their respective 95% confidence intervals (CI). Qualitative analysis was also carried out for those factors that did not provide sufficient data to carry out quantitative analysis.

Results: Six observational studies were used to conduct our study. Analysis revealed a significantly higher risk of subsequent bleeding episodes in the CYA injection group compared to the EUS group (OR = 0.28 (0.15, 0.53); p < 0.0001; I2 = 0%). Although an insignificant difference was observed rate of mortality between the two groups of patients (OR = 0.93 (0.21, 4.06); p = 0.92; I2 = 0%). The overall odds of cumulative adverse effects were significantly higher in the CYA injection group compared to the EUS group (OR = 0.43 (0.24, 0.75); p = 0.003; I2 = 11%). Other factors like cost, length of stay, etc were also discussed using a qualitative approach.

Discussion: Our study provides evidence suggesting that EUS-guided coiling is superior to CYA injections for treating gastric varices. This technique has been particularly successful in patients who experienced re-bleeding after receiving CYA therapy. Despite a higher initial cost, EUS-guided coiling in conjunction with the CYA technique was found to be more cost-effective. However, further investigation using randomized controlled trial (RCT) designs is necessary to supplement the evidence from observational studies.



Disclosures:


Hasan Al-Obaidi, MD¹, Omar Saab, MD², Ali Wakil, MD³, Nooraldin Merza, MD⁴, Mustafa Al-Obaidi, MD⁵, Pratiksha Moliya, MD⁶, Hussein Harb, MS⁷, Iya Agha, MS⁸, Sana Rabeeah, MD⁹, Abdallah Kobeissy, MD⁴. P4481 - An Updated Systematic Review and Meta-Analysis Comparing the Efficacy of EUS-Guided Coiling vs Cyanoacrylate Injection for Gastric Varices, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.