title: Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement.
abstract: The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted.Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival.Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included.Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed.
authors.affiliation: From the Guangdong Provincial Key Laboratory of Gastroenterology (WQ, YB, SL, QZ, FZ), and Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China (WQ, YB, SL, QZ, FZ); and Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China (YR).
authors.forename: Weiguang
authors.initials: W
authors.lastname: Qiao
authors.forename: Yutang
authors.initials: Y
authors.lastname: Ren
authors.forename: Yang
authors.initials: Y
authors.lastname: Bai
authors.forename: Side
authors.initials: S
authors.lastname: Liu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.forename: Fachao
authors.initials: F
authors.lastname: Zhi
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D003487:Cyanoacrylates / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D007267:Injections; D008026:Ligation; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate
chemical_list: D003487:Cyanoacrylates