EUS-guided Injection Versus Direct Endoscopic Injection Of Cyanoacrylate For Gastric Varices:A Meta-analysis

Objective:To evaluate the efficacy and safety of EUS-guided Injection versus Direct Endoscopic Injection of cyanoacrylate for Gastric Varices.Methods:All randomized controlled trials comparing the two treatments for esophagogastric varices were systematically searched from five databases(The Cochrane Library,Pub Med,Embase,CNKI,and Wanfang database).After literature screening and quality evaluation,all data were input into Rev Man5.3 software for Meta analysis.Results:Total of 7 studies and 526 patients were included.After analysis,it was found that in comparison with Direct Endoscopic Injection,EUS-guided Injection had higher hemostasis rate[OR:2.87,95%CI(1.19,6.92),P<0.05],and a lower incidence of rebleeding [OR: 0.30,95%CI(0.18,0.50),P < 0.05],the differences were statistically significant.Meanwhile,there was no statistical difference in Tissue glue dosage [MD:-0.27,95%CI(-1.18,0.63),P=0.05],however,subgroup analysis showed that EUS-guided tissue adhesive usage was less than direct endoscopic injection when the GOV1 percentage was less than 30% [MD:-1.06,95% CI(-1.15,-0.60)].incidence of postoperative fever [OR: 0.81,95%CI(0.36,1.82),P > 0.05],incidence of postoperative pain [OR: 1.10,95%CI(0.45,2.70),P > 0.05],the incidence of postoperative ectopic embolism [OR: 1.31,95%CI(0.30,5.79),P > 0.05].Conclusion:Compared with Direct Endoscopic Injection,EUS-guided Injection of tissue glue in the treatment of esophageal and gastric varices can improve the hemostatic efficiency and reduce the incidence of rebleeding,Ultrasound endoscopy-guided tissue adhesive injection was able to reduce the amount of tissue adhesive used for non-GOV1 types,but does not reduce the incidence of complications such as fever,pain and ectopic embolism after treatment.