Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

Robles-Medranda, Carlos; Nebel, João Autran; Puga-Tejada, Miguel; Oleas, Roberto; Baquerizo-Burgos, Jorge; Ospina-Arboleda, Jesenia; Valero, Manuel; Pitanga-Lukashok, Hannah

doi:10.4253/wjge.v13.i1.13

Cited by 13 publications

(12 citation statements)

References 10 publications

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“…The number of participants in each study ranged from 15 to 176. Of these studies, 10 were randomized controlled trials [ 22 , 24 , 26 , 27 , 30 , 45 , 47 , 51 , 52 , 54 ] and 24 were non-randomized studies (2 prospective cohort studies [ 28 , 36 ] and 22 retrospective comparative analyses [ 23 , 25 , 29 , 31 - 35 , 37 - 44 , 46 , 48 - 50 , 53 , 55 ]). Thirty studies were published full articles [ 22 - 31 , 33 - 38 , 39 - 43 , 45 - 47 , 49 - 54 ] and 4 were conference abstracts [ 32 , 39 , 44 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Among the 10 RCTs, only 4 studies [ 26 , 27 , 47 , 51 ] had low risk of bias and 6 RCTs had moderate [ 22 , 30 , 45 , 52 , 54 ] and 1 RCT had high risk of bias [ 24 ]. Among the 24 non-randomized studies, only 3 studies [ 36 , 50 , 55 ] had moderate risk of bias, while 20 studies had high risk of bias [ 23 , 24 , 28 , 29 , 31 - 35 , 37 - 44 , 48 , 49 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: A systematic review and network meta-analysis

Jearth¹,

Seth²,

Darak³

et al. 2023

ceh

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Aim of the study:There is a paradigm shift in the management of gastric varices with the availability of endoscopic ultrasound and radiologic interventions. The optimal choice of intervention remains a dilemma for most treating physicians. Material and methods: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Science-Direct for studies comparing endoscopic glue injection, endoscopic thrombin injection (THB), variceal band ligation, EUS-guided coiling, EUS-guided glue injection, EUS-guided coiling with glue (EUS-C+G), balloon occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS) for gastric varices in adults. The data on four outcomes -obliteration of varices, rebleeding, adverse effects, and mortalitywere pooled using a random-effects model. Treatment estimates were calculated as odds ratios (ORs) along with their 95% confidence interval (CI). The relative ranking of interventions for various outcomes was calculated as their surface under the cumulative ranking curve (SUCRA). Results: We identified 34 studies (10 randomized controlled trials, 24 non-randomized trials) with 2783 patients. Based on SUCRA plots, BRTO (SUCRA 95.1) had the highest rate of variceal obliteration followed by EUS-C+G (SUCRA 80.9). The risk of rebleeding was lowest with BRTO (SUCRA 85.1) followed by EUS-C+G (SUCRA 78.8). Moderate-severe adverse effects were least likely with THB (SUCRA 92.5) and highest with TIPS (SUCRA 3.7). In terms of mortality, EUS-C+G (73.5) had the lowest probability of overall mortality followed by TIPS (69.1). Conclusions: In this network meta-analysis, we found BRTO and EUS-guided therapies to be superior to endoscopic glue injection. However, the level of evidence remains low.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: A systematic review and network meta-analysis

Jearth¹,

Seth²,

Darak³

et al. 2023

ceh

View full text Add to dashboard Cite

show abstract

“…Comparison of EUS-coil with CYA vs endoscopic glue injection: Limited data exist (retrospective and one RCT) comparing EUS combination therapy vs conventional endoscopic glue injection[ 31 - 34 ]. Robles-Medranda et al [ 31 ] compared the cost-effectiveness of the two procedures and found EUS therapy to be better.…”

Section: Eus-guided Management Of Variceal Bleedmentioning

confidence: 99%

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Dhar¹,

Samanta²

2023

World J Gastrointest Endosc

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Endoscopic ultrasound (EUS) has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal (GI) diseases. The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions. EUS provides important clinical and anatomical information related to the vessels' size, appearance and location. Its excellent spatial resolution, use of colour doppler with or without contrast enhancement and ability to provide images “real-time” helps in precision while intervening vascular structures. Additionally, structures such as venous collaterals or varices can be dealt with optimally using EUS. EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension. It also helps to avoid radiation exposure in addition to being minimally invasive. These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions. EUS-guided portal vein (PV) access and therapy is a new kid on the block. EUS-guided portal pressure gradient measurement, injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology. Lastly, EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus. Herein, we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding, portal vein access and its related therapeutic interventions, cardiac access, and therapy. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.

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“…It can be challenging when associated with esophagitis. There is abundant evidence regarding the safety and efficacy of coil and glue embolization 2 3 even in primary prophylaxis for gastric varices 4 .…”

Section: Endoscopy E-videosmentioning

confidence: 99%

Transesophageal endoscopic ultrasound-guided coil and cyanoacrylate treatment of challenging esophageal varices bleeding associated with CREST syndrome ulcerative esophagitis

et al. 2022

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Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

Cited by 13 publications

References 10 publications

Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: A systematic review and network meta-analysis

Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: A systematic review and network meta-analysis

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Transesophageal endoscopic ultrasound-guided coil and cyanoacrylate treatment of challenging esophageal varices bleeding associated with CREST syndrome ulcerative esophagitis

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