PDF(Pubmed)
Abstract：
UNASSIGNED: Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding.
UNASSIGNED: We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I2 % statistics.
UNASSIGNED: Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; I2 = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; I2 = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; I2 = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; I2 = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; I2 = 0), 95.5% (CI, 80.3%-99.1%; I2 = 0), and 88.7% (CI, 76%-95.1%; I2 = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; I2 = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; I2 = 31), 92.3% (CI, 81.1%-97.1%; I2 = 0), and 84.5% (CI, 50.8%-96.7%; I2 = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; I2 = 16) and 20.6% (CI, 9.3%-39.5%; I2 = 66), respectively.
UNASSIGNED: Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.
UNASSIGNED: We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I2 % statistics.
UNASSIGNED: Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; I2 = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; I2 = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; I2 = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; I2 = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; I2 = 0), 95.5% (CI, 80.3%-99.1%; I2 = 0), and 88.7% (CI, 76%-95.1%; I2 = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; I2 = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; I2 = 31), 92.3% (CI, 81.1%-97.1%; I2 = 0), and 84.5% (CI, 50.8%-96.7%; I2 = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; I2 = 16) and 20.6% (CI, 9.3%-39.5%; I2 = 66), respectively.
UNASSIGNED: Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.
摘要：
■与食管静脉曲张相比，胃静脉曲张（GVs）与不受控制的出血和死亡的风险更高相关。虽然内窥镜胶注射疗法传统上用于GV的二级预防，有关初级预防的数据不断出现.最近,EUS引导疗法已用于GV出血。
■从成立到2022年6月，我们对几个主要数据库进行了全面搜索。我们的主要目标是估计治疗效果的汇总率，GV消失，GV复发,在一级和二级预防中使用EUS指导的再出血治疗。评估总体不良事件和技术故障。随机效应模型用于我们的荟萃分析，异质性使用I2%统计进行评估。
■纳入了包括604名患者的18项研究。在初级预防中，GV闭塞的合并率为90.2%(置信区间[CI]，81.1-95.2；I2=0）。结合EUS胶和线圈疗法，发生率为95.4%(CI,86.7%-98.5%;I2=0)。治疗后GV出血的合并率为4.9%(CI,1.8%-12.4%;I2=0)。在二级预防中，综合治疗疗效率为91.9%(CI,86.8%-95.2%;I2=12).用EUS胶，EUS线圈,和组合EUS胶和线圈，发生率为94.3%(CI，88.9%-97.1%；I2=0)，95.5%（CI，80.3%-99.1%；I2=0），和88.7%(CI，76%-95.1%；I2=14)，分别。GV闭塞的合并率为83.6%(CI,71.5%-91.2%;I2=74)。用EUS胶，EUS线圈,和组合EUS胶和线圈，发生率为84.6%(CI，75.9%-90.6%；I2=31)，92.3%（CI，81.1%-97.1%；I2=0），和84.5%(CI，50.8%-96.7%；I2=75)，分别。GV再出血和复发率分别为18.1%(CI,13.1%-24.3%;I2=16)和20.6%(CI,9.3%-39.5%;I2=66),分别。
■我们的分析表明，在GV的一级和二级预防中，EUS指导的GV治疗在技术上是可行的，临床上是成功的。
■从成立到2022年6月，我们对几个主要数据库进行了全面搜索。我们的主要目标是估计治疗效果的汇总率，GV消失，GV复发,在一级和二级预防中使用EUS指导的再出血治疗。评估总体不良事件和技术故障。随机效应模型用于我们的荟萃分析，异质性使用I2%统计进行评估。
■纳入了包括604名患者的18项研究。在初级预防中，GV闭塞的合并率为90.2%(置信区间[CI]，81.1-95.2；I2=0）。结合EUS胶和线圈疗法，发生率为95.4%(CI,86.7%-98.5%;I2=0)。治疗后GV出血的合并率为4.9%(CI,1.8%-12.4%;I2=0)。在二级预防中，综合治疗疗效率为91.9%(CI,86.8%-95.2%;I2=12).用EUS胶，EUS线圈,和组合EUS胶和线圈，发生率为94.3%(CI，88.9%-97.1%；I2=0)，95.5%（CI，80.3%-99.1%；I2=0），和88.7%(CI，76%-95.1%；I2=14)，分别。GV闭塞的合并率为83.6%(CI,71.5%-91.2%;I2=74)。用EUS胶，EUS线圈,和组合EUS胶和线圈，发生率为84.6%(CI，75.9%-90.6%；I2=31)，92.3%（CI，81.1%-97.1%；I2=0），和84.5%(CI，50.8%-96.7%；I2=75)，分别。GV再出血和复发率分别为18.1%(CI,13.1%-24.3%;I2=16)和20.6%(CI,9.3%-39.5%;I2=66),分别。
■我们的分析表明，在GV的一级和二级预防中，EUS指导的GV治疗在技术上是可行的，临床上是成功的。
