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Abstract：
BACKGROUND: Cyanoacrylate alone or in combination with other interventions, can be used to achieve variable rates of success in preventing rebleeding. Our study aims to assess the pooled risk of gastric and esophageal varices rebleeding after an initial treatment with cyanoacrylate alone and/or in combination with other treatments, by a systematic review of the literature and pooled analysis.
METHODS: PubMed, EMBASE, SCOPUS, and the Cochrane library were searched for studies that reported the risk of rebleeding during the follow-up period after treatment of gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using STATA Version 15 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity (I2).
RESULTS: A total of 39 studies were found to report treatment of either gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. When gastric varices are treated with cyanoacrylate alone, the risk of rebleeding during the follow-up period is 0.15(Confidence Interval: 0.11-0.18). When combined with lipiodol; polidocanol or sclerotherapy the rebleeding risks are 0.13 (CI:0.03-0.22), 0.10(CI:0.02-0.19), and 0.10(CI:0.05-0.18), respectively. When combined with percutaneous transhepatic variceal embolization; percutaneous transhepatic variceal embolization; endoscopic ultrasound guided coils; or with ethanolamine, the rebleeding risk are 0.10(CI:0.03-0.17), 0.10(CI:0.03-0.17), 0.07(CI:0.03-0.11) and 0.08(CI:0.02-0.14), respectively. When esophageal varices are treated with cyanoacrylate alone, the risk of rebleeding is 0.29(CI:0.11-0.47). When combined with percutaneous transhepatic variceal embolization; sclerotherapy; or band ligation, the risks of rebleeding are 0.16(CI:0.10-0.22), 0.12(CI:0.04-0.20) and 0.10(CI:0.04-0.24), respectively. When combined with a transjugular intrahepatic portosystemic shunt; or ethanolamine, the risks of rebleeding are 0.06(CI: - 0.01-0.12) and 0.02 (CI: - 0.02-0.05), respectively.
CONCLUSIONS: In treating both gastric and esophageal varices, cyanoacrylate produces better results in terms of lower risk of rebleeding when combined with other treatments than when used alone. The combination of cyanoacrylate with ethanolamine or with endoscopic ultrasound guided coils produces the lowest risk of rebleeding in esophageal and gastric varices, respectively. We call upon randomized trials to test these hypotheses.
METHODS: PubMed, EMBASE, SCOPUS, and the Cochrane library were searched for studies that reported the risk of rebleeding during the follow-up period after treatment of gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using STATA Version 15 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity (I2).
RESULTS: A total of 39 studies were found to report treatment of either gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. When gastric varices are treated with cyanoacrylate alone, the risk of rebleeding during the follow-up period is 0.15(Confidence Interval: 0.11-0.18). When combined with lipiodol; polidocanol or sclerotherapy the rebleeding risks are 0.13 (CI:0.03-0.22), 0.10(CI:0.02-0.19), and 0.10(CI:0.05-0.18), respectively. When combined with percutaneous transhepatic variceal embolization; percutaneous transhepatic variceal embolization; endoscopic ultrasound guided coils; or with ethanolamine, the rebleeding risk are 0.10(CI:0.03-0.17), 0.10(CI:0.03-0.17), 0.07(CI:0.03-0.11) and 0.08(CI:0.02-0.14), respectively. When esophageal varices are treated with cyanoacrylate alone, the risk of rebleeding is 0.29(CI:0.11-0.47). When combined with percutaneous transhepatic variceal embolization; sclerotherapy; or band ligation, the risks of rebleeding are 0.16(CI:0.10-0.22), 0.12(CI:0.04-0.20) and 0.10(CI:0.04-0.24), respectively. When combined with a transjugular intrahepatic portosystemic shunt; or ethanolamine, the risks of rebleeding are 0.06(CI: - 0.01-0.12) and 0.02 (CI: - 0.02-0.05), respectively.
CONCLUSIONS: In treating both gastric and esophageal varices, cyanoacrylate produces better results in terms of lower risk of rebleeding when combined with other treatments than when used alone. The combination of cyanoacrylate with ethanolamine or with endoscopic ultrasound guided coils produces the lowest risk of rebleeding in esophageal and gastric varices, respectively. We call upon randomized trials to test these hypotheses.
摘要：
背景：氰基丙烯酸酯单独或与其他干预措施联合使用，可用于预防再出血的成功率。我们的研究旨在评估单独使用氰基丙烯酸酯和/或与其他治疗联合使用初始治疗后胃和食管静脉曲张再出血的合并风险。通过对文献和汇总分析的系统回顾。
方法：PubMed，EMBASE,Scopus,我们在Cochrane图书馆中搜索了报道在单独使用氰基丙烯酸酯或与其他治疗联用治疗胃或食管静脉曲张后随访期间再出血风险的研究.标准误差,使用STATA第15版获得风险95%置信区间的上、下置信区间,该版本也用于生成林区进行汇总分析.根据异质性(I2)应用随机或固定效应模型。
结果：共有39项研究报告了单独使用氰基丙烯酸酯或与其他治疗联合使用治疗胃或食管静脉曲张。当仅用氰基丙烯酸酯治疗胃底静脉曲张时，随访期间再出血的风险为0.15(置信区间:0.11~0.18).当联合碘油、脊髓灰质炎或硬化治疗时，再出血风险为0.13(CI:0.03-0.22)，0.10（CI：0.02-0.19），和0.10（CI：0.05-0.18），分别。当联合经皮经肝静脉曲张栓塞术；经皮经肝静脉曲张栓塞术；内镜超声引导下弹簧圈；或乙醇胺，再出血风险为0.10（CI：0.03-0.17），0.10（CI：0.03-0.17），0.07（CI：0.03-0.11）和0.08（CI：0.02-0.14），分别。当食管静脉曲张单独用氰基丙烯酸酯治疗时，再出血风险为0.29(CI:0.11-0.47).当联合经皮经肝静脉曲张栓塞术；硬化疗法；或带状结扎，再出血的风险为0.16（CI：0.10-0.22），0.12（CI：0.04-0.20）和0.10（CI：0.04-0.24），分别。当联合经颈静脉肝内门体分流术或乙醇胺时，再出血的风险为0.06（CI：-0.01-0.12）和0.02（CI：-0.02-0.05），分别。
结论：在治疗胃和食管静脉曲张方面，与单独使用相比,氰基丙烯酸酯在再出血风险较低方面产生更好的结果.氰基丙烯酸酯与乙醇胺或内窥镜超声引导线圈的组合在食管和胃静脉曲张中产生再出血的风险最低。分别。我们呼吁随机试验来检验这些假设。
方法：PubMed，EMBASE,Scopus,我们在Cochrane图书馆中搜索了报道在单独使用氰基丙烯酸酯或与其他治疗联用治疗胃或食管静脉曲张后随访期间再出血风险的研究.标准误差,使用STATA第15版获得风险95%置信区间的上、下置信区间,该版本也用于生成林区进行汇总分析.根据异质性(I2)应用随机或固定效应模型。
结果：共有39项研究报告了单独使用氰基丙烯酸酯或与其他治疗联合使用治疗胃或食管静脉曲张。当仅用氰基丙烯酸酯治疗胃底静脉曲张时，随访期间再出血的风险为0.15(置信区间:0.11~0.18).当联合碘油、脊髓灰质炎或硬化治疗时，再出血风险为0.13(CI:0.03-0.22)，0.10（CI：0.02-0.19），和0.10（CI：0.05-0.18），分别。当联合经皮经肝静脉曲张栓塞术；经皮经肝静脉曲张栓塞术；内镜超声引导下弹簧圈；或乙醇胺，再出血风险为0.10（CI：0.03-0.17），0.10（CI：0.03-0.17），0.07（CI：0.03-0.11）和0.08（CI：0.02-0.14），分别。当食管静脉曲张单独用氰基丙烯酸酯治疗时，再出血风险为0.29(CI:0.11-0.47).当联合经皮经肝静脉曲张栓塞术；硬化疗法；或带状结扎，再出血的风险为0.16（CI：0.10-0.22），0.12（CI：0.04-0.20）和0.10（CI：0.04-0.24），分别。当联合经颈静脉肝内门体分流术或乙醇胺时，再出血的风险为0.06（CI：-0.01-0.12）和0.02（CI：-0.02-0.05），分别。
结论：在治疗胃和食管静脉曲张方面，与单独使用相比,氰基丙烯酸酯在再出血风险较低方面产生更好的结果.氰基丙烯酸酯与乙醇胺或内窥镜超声引导线圈的组合在食管和胃静脉曲张中产生再出血的风险最低。分别。我们呼吁随机试验来检验这些假设。
