Abstract：
BACKGROUND: Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding.
METHODS: Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included.
RESULTS: The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I2 = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I2 = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I2 = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I2 = 91.6%], 3% [95% CI - 2 to 8, I2 = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I2 = 0%], all-cause mortality rate was 17% [95% CI 12-22, I2 = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor.
CONCLUSIONS: Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding.
METHODS: Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included.
RESULTS: The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I2 = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I2 = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I2 = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I2 = 91.6%], 3% [95% CI - 2 to 8, I2 = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I2 = 0%], all-cause mortality rate was 17% [95% CI 12-22, I2 = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor.
CONCLUSIONS: Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
摘要：
背景：再出血是肝硬化患者胃底静脉曲张内镜下注射氰基丙烯酸酯的重要并发症。
目的：本系统综述和荟萃分析旨在评估内镜下注射氰基丙烯酸酯的有效性，并总结再出血的危险因素。
方法：检索数据库中2012年1月至2022年12月发表的文章。纳入评估内镜下注射氰基丙烯酸酯胶治疗胃底静脉曲张的有效性和再出血的危险因素的研究。
结果：最终分析包括来自24项研究的数据。止血率从65%到100%不等。胃静脉曲张复发的合并率为34%[95%CI21-46,I2=61.4%],早期再出血率为16%[95%CI11-20,I2=37.4%],晚期再出血率为39%[95%CI36-42,I2=90.9%],轻度和中度不良事件发生率为28%[95%CI24-31,I2=91.6%],3%[95%CI-2至8，I2=15.3%]，再出血相关死亡率为6%[95%CI2-10,I2=0%],全因死亡率为17%[95%CI12-22,I2=63.6%].胃底静脉曲张再出血的独立危险因素包括门静脉血栓形成,腹水,氰基丙烯酸酯体积,发热/全身炎症反应综合征，红色Wale标志,既往有静脉曲张出血史,活动性出血和胃旁静脉。质子泵抑制剂的使用可能是一个保护因素。
结论：内镜下注射氰基丙烯酸酯胶治疗胃底静脉曲张是一种安全有效的治疗方法。具有上述危险因素的肝硬化患者可能会从旨在减少门静脉高压的治疗中受益。抗生素预防，和抗凝，如果他们符合适应症。
目的：本系统综述和荟萃分析旨在评估内镜下注射氰基丙烯酸酯的有效性，并总结再出血的危险因素。
方法：检索数据库中2012年1月至2022年12月发表的文章。纳入评估内镜下注射氰基丙烯酸酯胶治疗胃底静脉曲张的有效性和再出血的危险因素的研究。
结果：最终分析包括来自24项研究的数据。止血率从65%到100%不等。胃静脉曲张复发的合并率为34%[95%CI21-46,I2=61.4%],早期再出血率为16%[95%CI11-20,I2=37.4%],晚期再出血率为39%[95%CI36-42,I2=90.9%],轻度和中度不良事件发生率为28%[95%CI24-31,I2=91.6%],3%[95%CI-2至8，I2=15.3%]，再出血相关死亡率为6%[95%CI2-10,I2=0%],全因死亡率为17%[95%CI12-22,I2=63.6%].胃底静脉曲张再出血的独立危险因素包括门静脉血栓形成,腹水,氰基丙烯酸酯体积,发热/全身炎症反应综合征，红色Wale标志,既往有静脉曲张出血史,活动性出血和胃旁静脉。质子泵抑制剂的使用可能是一个保护因素。
结论：内镜下注射氰基丙烯酸酯胶治疗胃底静脉曲张是一种安全有效的治疗方法。具有上述危险因素的肝硬化患者可能会从旨在减少门静脉高压的治疗中受益。抗生素预防，和抗凝，如果他们符合适应症。
