This individual patient data meta-analysis compared endovascular interventions against endoscopic cyanoacrylate injection for treating gastric variceal bleeding in patients with cirrhosis. The study included 1,240 patients and looked at rebleeding rates, survival, ascites, and hepatic encephalopathy. Results showed that both balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt significantly reduced the risk of all-cause rebleeding compared to injection therapy.
However, these procedures came with distinct trade-offs. Patients receiving balloon-occluded retrograde transvenous obliteration faced a higher risk of developing or worsening ascites. Those receiving a transjugular intrahepatic portosystemic shunt had a significantly increased risk of developing hepatic encephalopathy.
The researchers noted limitations including inconsistent trial outcomes and significant differences in results, particularly regarding the shunt procedure. While the data suggests endovascular options are superior for preventing rebleeding, readers should be aware of the specific side effects associated with each method. Long-term outcome data were limited in this analysis.