Summary of included studies

NoAuthors (year of publication)Number of patientsAge (years) of the patientsStudy designEndoscopic treatmentMethods of examinationStudy outcomesFollow-up period
1.Zheng, et al. (2019) [5]15355.2 ± 11.9Prospective cohortEndoscopic variceal band ligation (EVL); endoscopic injection sclerotherapy (EIS); or EVL and EIS.The endoscopy used for EUS probe examination was GIF-CV2o90, EU-ME1 ultrasound endoscopy host with UM-3R, 20-MHz catheter probe.EVL group demonstrated significantly shorter time of recurrence compared to EIS and EIS + EVL groups (10 months vs 13 months vs 12 months, respectively).Every 6 months for up to 3 years.
2.Robles-Medranda, et al. (2020) [9]6061.8 ± 7.8 (coils + cyanoacrylate group) and 61.6 ± 12.3 (coils)Single center, parallel-randomized controlled trialEUS-guided coil embolization and cyanoacrylate injection vs EUS-guided coil embolization alone.The EUS-guided procedure was conducted with a linear-array therapeutic echoendoscope (3.8 mm working channel) attached to an ultrasonography console. EUS-guided fine-needle puncture was performed with a 19-G needle. Coil deployment was performed (EUS-guided), followed by injection of 2-octyl-cyanoacrylate. Intravascular embolization was performed with Nester Embolization Coils (diameter: 10–16 mm. Straight length: 12–20 cm).The technical success rate was outstanding (100%) in both treatments. Varices were immediately disappeared in 86.7% of the patients treated with coils and cyanoacrylate; while only 13.3% of the patients treated with coil alone experienced the outcome. Significantly higher number of re-bleeding events was observed in groups treated with coils alone (20%) compared to groups treated with coils and cyanoacrylate injection (3.3%). Significantly lower number of patients free from reintervention was observed in groups treated with coils alone compared to combined treatment (60% vs 83.3%, p = 0.01).Three months after the initial procedure until up to 12 months after enrollment.
3.Lôbo, et al. (2019) [7]3249.1 ± 14.83 in group treated with EUS-guided coil plus cyanoacrylate and 57.69 ± 11.56 in group treated with conventional cyanoacrylateRandomized controlled trialEUS-guided coil combined with cyanoacrylate injection.Initially, conventional endoscopic examination was conducted to confirm the types of gastric varices and to assess the esophageal varices. EUS was then conducted with linear echoendoscope. Assessment of flow within the varices after each procedure was done by EUS with Doppler flow evaluation.No significant difference was found in the events of varix thrombosis between both groups. Meanwhile, asymptomatic pulmonary embolism was more common to be found in group treated with conventional cyanoacrylate compared to group treated with combined therapy (50% vs 25%).Average follow-up duration: 9 months
4.Liao, et al. (2014) [8]6656–57Prospective randomized control studyUtilization of EUS to evaluate the presence of para-esophageal varices.A two-channel therapeutic video-endoscope was used to perform endoscopy and EUS. The structure of para-esophageal and esophageal varices was assessed with a 12 MHz, radial type catheter ultrasound probe.A significantly lower cumulative probability of recurrence within two years was observed in propranolol group (28%) compared to control (68%). In propranolol group, para-esophageal varices were also significantly regressed within 3 months.Follow-up endoscopy and EUS were conducted every 3 months.
5.Kouanda, et al. (2021) [10]8060.5 ± 10.4Single-center observational studyEUS-guided coil and cyanoacrylate injection.EUS-guided coil and cyanoacrylate injection were performed under general anesthesia. All patients were given prophylactic intravenous antibiotics before the procedure. If the patients had high-risk esophageal varices, a conventional band ligation would be performed after gastric varices were successfully obliterated.The technical success rate achieved in all procedures was 100%. 96.7% of the patients had obliterated varices throughout the endoscopic follow-up. Around 71.7% required 2 treatment sessions, 3.4% needed 4 treatment sessions, and 1.7% needed 5 sessions for the varices to be completely obliterated.Surveillance endoscopy was conducted after 1 month, 3 months, and every 6 months.
6.Bazarbashi, et al. (2020) [11]10Mean age: 64 years oldRetrospective review of prospectively collected patients’ data.EUS-guided coil injection combined with hemostatic absorbable gelatin sponge.Initially, upper endoscopy was performed before EUS to evaluate active bleeding. After the upper endoscope was exchanged to a linear echoendoscope and gastric varices nest had been identified, transesophageal needle puncture (19-G) was used to perform transesophageal needle puncture. Multiple cylindrical-shaped coils would then be injected into the gastric varices nest (EUS-guided and fluoroscopy-guided).Technical success rate was 100% for EUS-guided coil embolization without any intraprocedural complications. No evidence of absorbable gelatin sponge extrusion or formation of ulcer was reported.Mean clinical follow-up days: 196 days (SD 110 days). A follow-up endoscopy was performed in all patients after a mean of 80 days (SD 33 days).
7. Kozieł, et al. (2019) [12]1629–75Single-center retrospective studyEUS-guided coil and cyanoacrylate injection.Initial evaluation with standard endoscopy. followed by assessment of varices with EUS. Next, varicose veins puncture and implantation of coil were performed with 19-G needles and 0.035-inch embolic coils.Therapeutic success rate was achieved in 75% of the patients after the first procedure. 92% of the patients who were treated with EUS-guided coils and cyanoacrylate injection achieved therapeutic success.Endoscopic and endosonography assessments at 1, 3, and 6 months. Average follow-up period: 327 days.
8.Khoury, et al. (2018) [13]1013–80Retrospective case seriesEUS-guided coilingEUS-guided angiotherapy procedure was performed with a linear-array echoendoscope. Varices were accessed with a 19-G needle. A 50–10 mm-long and 8–15 mm-diameter synthetic, stainless steel fiber coil was then deployed. Some patients were injected with synthetic cyanoacrylate surgical glue after coil insertion.Twenty-percent of the cases achieved complete eradication of gastric varices; while 50% of the cases accomplished near complete eradication of gastric varices. Around 30% of the patients needed another 1–2 coiling sessions to achieve a better response.Average follow-up time: 9.7 months.
9.Bhat, et al. (2016) [14]15219–88Retrospective observational studyEUS-guided coil and cyanoacrylate treatment.The process began with intraluminal water filling of the gastric fundus. After that, echoendoscope will be positioned with transesophageal-transcrural approach or transgastric approach. Intravascular puncture of gastric fundal varices will then be directed by EUS. Embolization coils (diameter: 10–20 mm) will then be delivered along with immediate injection of cyanoacrylate.Technical success rate was achieved in > 99% of the patients. From follow-up EUS examinations, 93% of the patients showed complete obliteration of gastric fundal varices. Approximately 3% of the patients suffered from re-bleeding.Average follow-up: 436 days.
10.Fujii-Lau, et al. (2015) [15]1451–72Retrospective observational studyEUS-guided variceal therapy with coil injection.EUS procedure was performed with a curvilinear echoendoscope, fluoroscopy-guided. Prophylactic intravenous and post-procedure oral antibiotics were administered.Eight out of fourteen patients did not experience any re-bleeding episode. Significant decrease of re-bleeding events was also observed in three patients with choledochal varices.Median follow-up: 12 months.