Abstract：
BACKGROUND: EUS-guided combination therapy (coil and hemostatic glue) for bleeding and non-bleeding gastric varices has recently attracted considerable attention after promising results were published in multiple small studies. We performed a meta-analysis to investigate the safety and efficacy of EUS-guided combination therapy in the treatment of GVs.
METHODS: Publications investigating the safety and efficacy of EUS-guided combination therapy in patients with gastric varices were searched in Medline, Ovid Journals, Medline non-indexed citations and Cochrane Central Register of Controlled Trials. Pooling was conducted by both fixed and random effects model.
RESULTS: In pooled analysis of 10 studies (N = 323), the technical success of EUS-guided combination therapy was 98.66% (95% CI 97.14-99.62). The pooled variceal obliteration rate after first session of treatment was 78.31% (95% CI 73.05-83.14). In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.79% (95% CI 94.28-98.60). The pooled rate of hemorrhage from treated gastric varices was 4.92% (95% CI 2.85-7.52). After EUS-guided combination therapy, the pooled percentage of patients developing abdominal pain was 9.79% (95% CI 6.82-13.24), pulmonary embolism was 2.20% (95% CI 0.89-4.06), febrile episodes was 1.17% (95% CI 0.30-2.61), and procedure-related bleeding was noted in 2.62% (95% CI 1.18-4.63) of the patients. Subgroup analysis of studies using coil embolization and cyanoacrylate injection showed pooled variceal obliteration rate of 77.92% (95% CI 72.35-83.01) after first session of treatment. In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.76% (95% CI 94.11-98.65). The pooled rate of re-bleeding from treated gastric varices was 5.09% (95% CI 2.90-7.83).
CONCLUSIONS: This meta-analysis suggests that EUS-guided combination therapy is safe and effective for patients with gastric varices and should be considered in the clinical management of these patients.
METHODS: Publications investigating the safety and efficacy of EUS-guided combination therapy in patients with gastric varices were searched in Medline, Ovid Journals, Medline non-indexed citations and Cochrane Central Register of Controlled Trials. Pooling was conducted by both fixed and random effects model.
RESULTS: In pooled analysis of 10 studies (N = 323), the technical success of EUS-guided combination therapy was 98.66% (95% CI 97.14-99.62). The pooled variceal obliteration rate after first session of treatment was 78.31% (95% CI 73.05-83.14). In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.79% (95% CI 94.28-98.60). The pooled rate of hemorrhage from treated gastric varices was 4.92% (95% CI 2.85-7.52). After EUS-guided combination therapy, the pooled percentage of patients developing abdominal pain was 9.79% (95% CI 6.82-13.24), pulmonary embolism was 2.20% (95% CI 0.89-4.06), febrile episodes was 1.17% (95% CI 0.30-2.61), and procedure-related bleeding was noted in 2.62% (95% CI 1.18-4.63) of the patients. Subgroup analysis of studies using coil embolization and cyanoacrylate injection showed pooled variceal obliteration rate of 77.92% (95% CI 72.35-83.01) after first session of treatment. In patients requiring single or multiple treatment sessions, the overall variceal obliteration rate was 96.76% (95% CI 94.11-98.65). The pooled rate of re-bleeding from treated gastric varices was 5.09% (95% CI 2.90-7.83).
CONCLUSIONS: This meta-analysis suggests that EUS-guided combination therapy is safe and effective for patients with gastric varices and should be considered in the clinical management of these patients.
摘要：
背景：在多项小型研究中发表了有希望的结果后，EUS指导的出血和非出血胃底静脉曲张的联合治疗（线圈和止血胶）最近引起了相当大的关注。我们进行了一项荟萃分析，以研究EUS指导的联合治疗GV的安全性和有效性。
方法：在Medline搜索了调查EUS指导的联合治疗胃静脉曲张患者的安全性和有效性的出版物，Ovid期刊,Medline非索引引文和Cochrane中央对照试验登记册。采用固定效应模型和随机效应模型进行汇集。
结果：在10项研究的汇总分析中（N=323），EUS指导联合治疗的技术成功率为98.66%(95%CI97.14~99.62).第一次治疗后合并的静脉曲张闭塞率为78.31%（95%CI73.05-83.14）。在需要单次或多次治疗的患者中，总静脉曲张闭塞率为96.79%(95%CI94.28~98.60)。经治疗的胃静脉曲张出血的合并率为4.92％（95％CI2.85-7.52）。在EUS指导的联合治疗后，出现腹痛的患者的合并百分比为9.79％（95％CI6.82-13.24），肺栓塞为2.20%（95%CI0.89-4.06），发热发作率为1.17%(95%CI0.30-2.61)，2.62%(95%CI1.18~4.63)的患者出现手术相关出血.使用线圈栓塞和氰基丙烯酸酯注射的研究的亚组分析显示，在第一次治疗后，合并的静脉曲张闭塞率为77.92％（95％CI72.35-83.01）。在需要单次或多次治疗的患者中，总静脉曲张闭塞率为96.76%(95%CI94.11~98.65).经治疗的胃静脉曲张再出血的合并率为5.09％（95％CI2.90-7.83）。
结论：这项荟萃分析表明，EUS指导的联合治疗对胃静脉曲张患者是安全有效的，应在这些患者的临床治疗中加以考虑。
方法：在Medline搜索了调查EUS指导的联合治疗胃静脉曲张患者的安全性和有效性的出版物，Ovid期刊,Medline非索引引文和Cochrane中央对照试验登记册。采用固定效应模型和随机效应模型进行汇集。
结果：在10项研究的汇总分析中（N=323），EUS指导联合治疗的技术成功率为98.66%(95%CI97.14~99.62).第一次治疗后合并的静脉曲张闭塞率为78.31%（95%CI73.05-83.14）。在需要单次或多次治疗的患者中，总静脉曲张闭塞率为96.79%(95%CI94.28~98.60)。经治疗的胃静脉曲张出血的合并率为4.92％（95％CI2.85-7.52）。在EUS指导的联合治疗后，出现腹痛的患者的合并百分比为9.79％（95％CI6.82-13.24），肺栓塞为2.20%（95%CI0.89-4.06），发热发作率为1.17%(95%CI0.30-2.61)，2.62%(95%CI1.18~4.63)的患者出现手术相关出血.使用线圈栓塞和氰基丙烯酸酯注射的研究的亚组分析显示，在第一次治疗后，合并的静脉曲张闭塞率为77.92％（95％CI72.35-83.01）。在需要单次或多次治疗的患者中，总静脉曲张闭塞率为96.76%(95%CI94.11~98.65).经治疗的胃静脉曲张再出血的合并率为5.09％（95％CI2.90-7.83）。
结论：这项荟萃分析表明，EUS指导的联合治疗对胃静脉曲张患者是安全有效的，应在这些患者的临床治疗中加以考虑。
