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Cyanoacrylate injection compared with band ligation for acute gastric variceal hemorrhage: a meta-analysis of randomized controlled trials and observational studies.

Ye X, Huai J, Chen Y - Gastroenterol Res Pract (2014)

Bottom Line: For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test.Results.Additional studies are warranted to enable definitive conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang 321000, China.

ABSTRACT
Background. Cyanoacrylate injection (GVO) and band ligation (GVL) are effective treatments for gastric variceal hemorrhage. However, data on the optimal treatment are still controversial. Methods. For our overall analysis, relevant studies were identified from several databases. For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test. Results. Seven studies were included. Compared with GVL, GVO was associated with increased likelihood of hemostasis of active bleeding (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.19-4.51) and a longer gastric variceal rebleeding-free period (hazard ratio = 0.37; 95% CI = 0.24-0.56). No significant differences were observed between GVL and GVO for mortality (hazard ratio = 0.66; 95% CI = 0.43-1.02), likelihood of variceal obliteration (OR = 0.89; 95% CI = 0.52-1.54), number of treatment sessions required for complete variceal eradication (weighted mean difference = -0.45; 95% CI = -1.14-0.23), or complications (OR = 1.02; 95% CI = 0.48-2.19). Conclusion. GVO may be superior to GVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications. Additional studies are warranted to enable definitive conclusions.

No MeSH data available.


Related in: MedlinePlus

Comparison of the overall incidence of complications in the GVO and GVL groups. GVO, cyanoacrylate injection; GVL, band ligation; CI, confidence interval; OR, odds ratio.
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fig8: Comparison of the overall incidence of complications in the GVO and GVL groups. GVO, cyanoacrylate injection; GVL, band ligation; CI, confidence interval; OR, odds ratio.

Mentions: All seven trials (648 patients) reported the occurrence of complications in the GVO and GVL groups [8, 9, 12, 13, 15–17]. Overall, complications occurred in 119 patients (39.02%) of the GVO group and 71 patients (27.10%) of the GVL group. In six studies there were fewer complications in the GVO group than in the GVL group, but the difference in each case was not significant [8, 9, 13, 15–17]; in the other study there were significantly fewer complications in the GVL group than in the GVO group [12]. In the pooled data analysis, the incidence of complications was similar in the GVO and GVL groups (OR = 1.02; 95% CI = 0.48–2.19; Figure 8). However, there was significant intertrial heterogeneity (I2 = 72.2%; P = 0.001). We considered that the source of intertrial heterogeneity might be ascribed to the study by El Amin et al. [12], as the definition of complication was not strictly limited in this study yet conditions like hepatic encephalopathy and hepatorenal syndrome were included. It is likely that these conditions were not caused by GVO or GVL per se but rather were associated with cirrhosis. When we excluded this study, the intertrial heterogeneity became nonsignificant (OR = 0.75; 95% CI = 0.49–1.14; I2 = 0.0%, P = 0.657). The most common complications related to GVO and GVL were ulcers or ulcer bleeding and infections. Infections included sepsis, bacteremia, pneumonia, spontaneous bacterial peritonitis, urinary tract infection, fever, and leukocytosis. Data on specific categories of complications were reported in all studies, and the summary results are shown in Table 3. The incidence of ulcers or ulcer bleeding was significantly lower in the GVO group than in the GVL group (OR = 0.32, 95% CI = 0.17–0.67; I2 = 17.7%, P = 0.302).


Cyanoacrylate injection compared with band ligation for acute gastric variceal hemorrhage: a meta-analysis of randomized controlled trials and observational studies.

Ye X, Huai J, Chen Y - Gastroenterol Res Pract (2014)

Comparison of the overall incidence of complications in the GVO and GVL groups. GVO, cyanoacrylate injection; GVL, band ligation; CI, confidence interval; OR, odds ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020398&req=5

fig8: Comparison of the overall incidence of complications in the GVO and GVL groups. GVO, cyanoacrylate injection; GVL, band ligation; CI, confidence interval; OR, odds ratio.
Mentions: All seven trials (648 patients) reported the occurrence of complications in the GVO and GVL groups [8, 9, 12, 13, 15–17]. Overall, complications occurred in 119 patients (39.02%) of the GVO group and 71 patients (27.10%) of the GVL group. In six studies there were fewer complications in the GVO group than in the GVL group, but the difference in each case was not significant [8, 9, 13, 15–17]; in the other study there were significantly fewer complications in the GVL group than in the GVO group [12]. In the pooled data analysis, the incidence of complications was similar in the GVO and GVL groups (OR = 1.02; 95% CI = 0.48–2.19; Figure 8). However, there was significant intertrial heterogeneity (I2 = 72.2%; P = 0.001). We considered that the source of intertrial heterogeneity might be ascribed to the study by El Amin et al. [12], as the definition of complication was not strictly limited in this study yet conditions like hepatic encephalopathy and hepatorenal syndrome were included. It is likely that these conditions were not caused by GVO or GVL per se but rather were associated with cirrhosis. When we excluded this study, the intertrial heterogeneity became nonsignificant (OR = 0.75; 95% CI = 0.49–1.14; I2 = 0.0%, P = 0.657). The most common complications related to GVO and GVL were ulcers or ulcer bleeding and infections. Infections included sepsis, bacteremia, pneumonia, spontaneous bacterial peritonitis, urinary tract infection, fever, and leukocytosis. Data on specific categories of complications were reported in all studies, and the summary results are shown in Table 3. The incidence of ulcers or ulcer bleeding was significantly lower in the GVO group than in the GVL group (OR = 0.32, 95% CI = 0.17–0.67; I2 = 17.7%, P = 0.302).

Bottom Line: For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test.Results.Additional studies are warranted to enable definitive conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang 321000, China.

ABSTRACT
Background. Cyanoacrylate injection (GVO) and band ligation (GVL) are effective treatments for gastric variceal hemorrhage. However, data on the optimal treatment are still controversial. Methods. For our overall analysis, relevant studies were identified from several databases. For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test. Results. Seven studies were included. Compared with GVL, GVO was associated with increased likelihood of hemostasis of active bleeding (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.19-4.51) and a longer gastric variceal rebleeding-free period (hazard ratio = 0.37; 95% CI = 0.24-0.56). No significant differences were observed between GVL and GVO for mortality (hazard ratio = 0.66; 95% CI = 0.43-1.02), likelihood of variceal obliteration (OR = 0.89; 95% CI = 0.52-1.54), number of treatment sessions required for complete variceal eradication (weighted mean difference = -0.45; 95% CI = -1.14-0.23), or complications (OR = 1.02; 95% CI = 0.48-2.19). Conclusion. GVO may be superior to GVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications. Additional studies are warranted to enable definitive conclusions.

No MeSH data available.


Related in: MedlinePlus