Meta-analysis Of The Efficacy And Safety Of Endoscopic Ultrasonography And Traditional Endoscopy In The Treatment Of Esophageal And Gastric Varices

Purpose:To explore the value of endoscopic ultrasonography(EUS)in the treatment of esophageal and gastric varices by meta-analysis,and to summarize and analyze the efficacy and safety of endoscopic ultrasonography and traditional endoscopy in the treatment of esophageal and gastric varices,in order to provide a certain basis for clinicians in the selection of endoscopic treatment methods for esophageal and gastric varices.Method:Pub Med,Web of Science,Cochrane Library,CBM,CNKI,Wanfang and VIP databases were searched by computer.According to the principle of PICOS,the studies about the efficacy and safety of EUS-guided treatment of esophageal and gastric varices were searched by the combination of subject words and free words.The time limit for retrieval is from the establishment of the database to December 2022.The literatures were screened according to the inclusion and exclusion criteria,and the included randomized controlled trials and cohort studies were evaluated by Cochrane collaboration’s tool for assessing risk of bias and the Newcastle-Ottawa Scale(NOS),respectively.After extracting the data,meta-analysis was performed by Revman5.4 software.Result:A total of 17 studies were included,including 8 randomized controlled trials and 9 cohort studies,including 1322 patients,endoscopic ultrasound group(n = 638)and traditional endoscopy group(n = 694).Among them,9 studies were about tissue adhesive injection(including 1 study of modified "sandwich" method,2studies of endoscopic selective varices devascularization),3studies were about sclerosing agent injection therapy,and the other 5 studies compared EUS-guided injection of tissue adhesive plus coils with traditional endoscopic tissue adhesive injection.The results suggest that: Compared with traditional endoscopic treatment,EUS-guided treatment has a higher hemostatic rate[RR=1.16,95%CI(1.06,1.28),Z=3.18,P=0.001],a lower rebleeding rate[RR=0.37,95%CI(0.27,0.50),Z=6.46,P < 0.00001],it needs less dose of tissue glue[MD=-1.19,95%CI(-1.88,-0.50),Z=3.39,P=0.0007],and the 6-month mortality rate was lower[RR=0.55,95%CI(0.37,0.84),Z=2.82,P=0.005],the differences between the above studies are statistically significant.There was no statistical difference in the incidence of postoperative complications between the two groups,including fever[RR=1.01,95%CI(0.55,1.86),Z=0.03,P=0.98],pain[RR=1.13,95%CI(0.70,1.80),Z=0.49,P=0.62],and ectopic embolism [RR=0.46,95%CI(0.21,1.03),Z=1.89,P=0.06].Conclusion:EUS-guided treatment of esophageal and gastric varices is effective and relatively safe.Compared with the traditional endoscopic treatment,it has higher hemostatic rate,lower rebleeding rate and 6-month mortality.It needs less dose of tissue glue.There is no significant difference in the incidence of complications between the two groups.