Endoscopic Thrombin Injection for Gastric Variceal Bleeding: A Systematic Review and Meta-Analysis of Observational and Trial Data.
Endoscopic thrombin injection shows a high initial success rate for controlling gastric variceal bleeding, but the evidence is based on observational studies with varying quality.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This meta-analysis evaluated the efficacy and safety of endoscopic thrombin injection (ETI) for gastric variceal bleeding in patients with portal hypertension. A total of 417 patients from 13 studies were analyzed, revealing a high initial hemostasis rate and low complication rates. No therapeutic claims are made.
Abstract
<h4>Objective</h4>The safety of endoscopic thrombin injection (ETI) for treating the bleeding of gastric varix (GV) in patients with portal hypertension requires further evaluation. This meta-analysis systematically reviews the available evidence on the efficacy and safety of ETI for GV bleeding.<h4>Methods</h4>Two researchers independently screened and extracted data from all relevant original articles published from database inception to May 2025. Study quality was assessed using the Methodological Index for Non-Randomized Studies tool. Meta-analysis was performed using RevMan 5.3 software, with risk of bias assessed via risk of bias plots and funnel plots.<h4>Results</h4>Thirteen studies involving 417 patients were included. Meta-analysis revealed an initial hemostasis rate of 93% (95% confidence interval [<i>CI</i>]: 0.89-0.95), a 5-day rebleeding rate of 11% (95% <i>CI</i>: 0.07-0.17), a late rebleeding rate of 14% (95% <i>CI</i>: 0.11-0.19), a complete GV obliteration rate of 36% (95% <i>CI</i>: 0.11-0.73), and a 6-week GV-related mortality rate of 9% (95% <i>CI</i>: 0.06-0.15). The overall complication rate was 2.2% (9/417), with fever and leukocytosis being the most common events.<h4>Conclusion</h4>Endoscopic thrombin injection for GV bleeding appears to achieve high initial hemostasis with low rates of rebleeding in the available studies. Reported complication rates were low, though systematic assessment was not consistently described across studies. It is suggested the potential efficacy and an acceptable safety profile within the available evidences.
Background
This paper addresses the clinical question of the safety and efficacy of endoscopic thrombin injection (ETI) for treating gastric variceal bleeding, a significant concern in patients with portal hypertension. Prior studies have suggested varying outcomes for ETI, but a comprehensive evaluation of its effectiveness and safety profile was lacking. This systematic review and meta-analysis aims to consolidate existing evidence to inform clinical practice.
Methods
The study design involved a systematic review and meta-analysis of observational and trial data. A total of 13 studies were included, with a combined sample size of 417 patients. The studies were screened and data extracted independently by two researchers, and the quality of the studies was assessed using the Methodological Index for Non-Randomized Studies tool. Meta-analysis was performed using RevMan 5.3 software.
Results
The primary endpoint revealed an initial hemostasis rate of 93% (95% CI: 0.89-0.95). Additionally, the meta-analysis reported a 5-day rebleeding rate of 11% (95% CI: 0.07-0.17) and a late rebleeding rate of 14% (95% CI: 0.11-0.19). The complete gastric variceal obliteration rate was 36% (95% CI: 0.11-0.73), and the 6-week mortality rate related to gastric variceal bleeding was 9% (95% CI: 0.06-0.15). The overall complication rate was reported at 2.2% (9/417).
Interpretation
The findings suggest that ETI achieves a high initial hemostasis rate, which is statistically significant. However, the clinical significance of the rebleeding and mortality rates should be interpreted with caution, as they may not represent a meaningful impact on long-term outcomes. The study's limitations include the observational nature of the included studies, potential biases, and the lack of consistent complication reporting, which may confound the conclusions drawn.
Key findings
- Initial hemostasis rate of 93% (95% CI: 0.89-0.95) across 13 studies, n=417.
- 5-day rebleeding rate of 11% (95% CI: 0.07-0.17).
- Late rebleeding rate of 14% (95% CI: 0.11-0.19).
- Complete gastric variceal obliteration rate of 36% (95% CI: 0.11-0.73).
- 6-week gastric variceal-related mortality rate of 9% (95% CI: 0.06-0.15).
- Overall complication rate of 2.2% (9/417).
Limitations
- Observational studies included, varying quality.
- Systematic assessment of complications not consistently described.
- Potential for publication bias.
- Short follow-up duration in some studies.
- Limited generalizability due to study heterogeneity.