S1045 EUS-Guided Primary, Secondary Prophylaxis Treatment of Gastric Varices: A Systematic Review With Meta-Analysis

Abstract

Introduction: Gastric varices (GV) increase the risk of gastrointestinal bleeding and carry a significant mortality risk, especially in the setting of portal hypertension. A major treatment modality for GV includes endoscopic ultrasound (EUS) guided glue and/ or coil injection. In this meta-analysis study, we aim to address the efficacy of EUS guided glue and/ or coil injection in the treatment of GV in primary and secondary prophylaxis. Methods: We conducted a comprehensive search of several databases including Medline, Scopus, Embase to identify studies from 2000-2019 that evaluated EUS guided therapy in the treatment of GV for primary and/or secondary prophylaxis. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, early re-bleeding, and late re-bleeding with EUS guided therapy of GV in primary and secondary prophylaxis. Calculation was done by standard meta-analysis methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. Results: A total of 13 studies were included in the final analysis. The EUS guided treatment efficacy of primary prophylaxis was 95% (95% CI [85.7-98.4%]) and secondary prophylaxis was 94.3% [83.6-98.1]. GV obliteration was 68.3% [43.4-85.8] for primary prophylaxis and 65.8% [38.8-85.4] for secondary prophylaxis. GV recurrence was 10% [2.5-32.8] in primary prophylaxis and 4.3% [1.7-10.5] in secondary prophylaxis. Early re-bleeding was seen in 6.7% [1.7-23.1] of primary prophylaxis cases and 5.5% [2.3-12.6] of secondary prophylaxis. Late re-bleeding was seen in 6% [2.3-14.9] of primary prophylaxis cases and 12.6% [9.3-16.8] of secondary prophylaxis cases. We conducted sub-group analysis with respect to studies published as abstracts and full manuscripts, and by sample-size. The results summarized in Table 1. Conclusion: Our meta-analysis study illustrates that EUS-guided therapy of GV may demonstrate excellent short and long-term clinical outcomes in both primary and secondary prophylaxis. This was shown by high EUS guided treatment efficacy of 95% and 94.3% in primary and secondary prophylaxis respectively. In addition, a low GV recurrence of 4.5% in secondary prophylaxis is a key positive finding; however, the late re-bleeding rate of 12.6% in secondary prophylaxis needs further evaluation and future study. Nevertheless, our study highlights that early EUS-guided therapy should be considered in the treatment of GV regardless of primary or secondary prophylaxis.Table 1.: Summary of pooled results