Balloon‐occluded retrograde transvenous obliteration versus endoscopic injection for gastric variceal bleeding: a systematic review and meta‐analysis

Abstract

Summary Background and Aims Bleeding from gastric varices presents a clinical challenge with high mortality and limited treatment options. Balloon‐occluded retrograde transvenous obliteration and endoscopic injection therapy have been used in the management of gastric varices. We performed a meta‐analysis comparing the two approaches. Methods A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was performed until February 2019. Two independent reviewers systematically identified trials that compared Balloon‐occluded retrograde transvenous obliteration versus endoscopic injection therapy in the management of gastric variceal bleeding. A meta‐analysis was performed using a fixed effects model to assess the primary outcome (gastric variceal rebleeding) and secondary outcomes (complete obliteration of gastric varices, aggravation of oesophageal varices and mortality). Results The search yielded five comparative studies involving 453 patients. The rate of gastric variceal rebleeding was 23.5% in the endoscopic injection therapy group and 3.6% in the Balloon‐occluded retrograde transvenous obliteration group, with a mean odds ratio of 0.11, P < 0.00001 (95% CI: 0.05‐0.25). The rate of complete obliteration of gastric varices was 72% in the endoscopic injection therapy group and 95% in the Balloon‐occluded retrograde transvenous obliteration group: odds ratio 8.95, P < 0.0001 (95% CI: 3.16‐25.35). There was no statistical significant difference for aggravation of oesophageal varices and mortality rate between the two groups. Conclusions Balloon‐occluded retrograde transvenous obliteration was associated with lower odds of rebleeding and higher odds of complete obliteration of gastric varices. A randomied controlled trial is needed to verify these findings.

Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

“…From an IR perspective, BRTO is an effective treatment modality for bleeding GV. Compared with cyanoacrylate injection, BRTO is associated with lower odds of rebleeding and higher odds of complete GV obliteration according to a recent meta-analysis [ 27 ]. However, the large volume of instilled sclerosant during BRTO dissipates in the systemic circulation, potentially leading to profound systemic disturbances and deleterious adverse events.…”