S0635 A Comparative Study of the Efficacy of Endoscopic Injection of Cyanoacrylate Glue vs Other Interventional Modalities for Treatment of Acute Gastric Variceal Bleeding: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Cyanoacrylate glue is currently the main endoscopic therapeutic option for treatment of bleeding gastric varices. Recent studies have demonstrated that a multitude of different techniques appear to have similar efficacy and safety. This study aimed to conduct a systematic review and meta-analysis to evaluate the efficacy of cyanoacrylate glue injection versus other endoscopic and interventional modalities, including band ligation, sclerotherapy, or transjugular intrahepatic portosystemic shunt (TIPS) in the management of gastric variceal bleeding. METHODS: Multiple databases were searched through November 2018 for studies involving adults with portal hypertension and/or cirrhosis with bleeding gastric varices. Data was gathered to compare cyanoacrylate glue versus band ligation, sclerotherapy, or TIPS in achieving control of active bleeding from gastric varices within the first 24 hours. Secondary outcomes analyzed included rebleeding rate and adverse event rate. RESULTS: A comprehensive search identified 1068 potential articles with 14 comparative studies fulfilling inclusion criteria for data extraction. These studies included 1270 total patients: 634 patients underwent cyanoacrylate glue injection, 325 patients underwent endoscopic band ligation, 219 patients underwent TIPS, and 92 patients underwent sclerotherapy. Pooled analysis was performed, and odds ratios were obtained. Control of active bleeding within the first 24 hours was statistically significant favoring cyanoacrylate in all three comparisons of cyanoacrylate glue vs. band ligation, sclerotherapy, and TIPS, respectively (Figure 1). Rate of adverse events showed no significant differences among the three comparison groups (Figure 2). Rate of rebleeding also showed no significant difference among the groups (Figure 3). CONCLUSION: This meta-analysis highlights that cyanoacrylate glue injections were superior to band ligation, sclerotherapy, or TIPS in controlling active gastric variceal bleeding within the first 24 hours. Cyanoacrylate glue injections also showed no significant differences in adverse events or rebleeding rates when compared against the other interventions. These results suggest that cyanoacrylate glue injection should remain a primary therapeutic option for the treatment of gastric variceal bleeds. However, comparative studies remain limited, and further analyses evaluating the many therapeutic options available for the treatment of gastric varices against each other are warranted.Figure 1.: Bleeding Control of Gastric Varices within 24 hours in Cyanoacrylate Glue Injection vs. Band Ligation, Sclerotherapy, or TIPS.Figure 2.: Rate of Adverse Events after Cyanoacrylate Glue Injection vs. Band Ligation, Sclerotherapy, or TIPS.Figure 3.: Rate of Rebleeding after Therapy with Cyanoacrylate Glue Injection vs. Band Ligation, Sclerotherapy, or TIPS.