Pathophysiological management of gastric varices: From hemodynamics to targeted therapies

Table 4 Summary of meta-analyses comparing the various therapeutic modalities in the management of gastric varices

Ref.	Study type	Comparison	Sample size	Key efficacy outcomes	Safety outcomes	Key conclusion
Yu et al[55]	Meta-analysis	BRTO vs TIPS	435 (5 studies)	Similar success (91% vs 89%)	Rebleeding lower with BRTO (10.6% vs 18.7%); HE lower (0% vs 23%)	BRTO preferred; TIPS increases HE
Paleti et al[53]	Meta-analysis	BRTO vs TIPS	676 (7 studies)	No difference in technical success/hemostasis	Rebleeding ⇩ with BRTO (OR 0.30); HE ⇩ (OR 0.06); mortality ⇩ (OR 0.43)	BRTO superior to TIPS for rebleeding, HE, and survival
Wang et al[54]	Meta-analysis	BRTO vs TIPS	9 studies	Similar immediate hemostasis	Rebleeding higher with TIPS (RR 2.61); HE ⇧ with TIPS (RR 16.1)	BRTO provides better survival and lower rebleeding
Osman et al[56]	Network meta-analysis (RCTs)	BRTO vs TIPS vs ECI vs NSBB	647 (9 studies)	BRTO lowest rebleeding (RR 0.04 vs NSBB)	β-blockers worst outcomes	BRTO most effective for secondary prophylaxis
Giri et al[6]	Network meta-analysis	Multiple (radiological and endoscopic)	2783 (34 studies)	BRTO highest obliteration (SUCRA 95.1); EUS-C+G second (80.9)	Adverse events highest with TIPS; lowest with thrombin	BRTO and EUS superior to ECI; top-ranked therapies
Florencio de Mesquita et al[35]	Meta-analysis	EUS (coil + glue) vs ECI	445 (6 studies)	Rebleeding ⇩ with EUS (OR 0.22); reintervention ⇩ (OR 0.29) with EUS	No difference in embolism/mortality	EUS superior to ECI with similar safety
Mohammadpour et al[57]	Meta-analysis	EUS-coil + glue vs endoscopic modalities	579 (9 studies)	Higher obliteration (RR 1.18); rebleeding ⇩ (RR 0.36)	Adverse events ⇩ (RR 0.55)	EUS combination therapy superior to endoscopic options
Biswas et al[58]	Individual patient meta-analysis	BRTO/TIPS vs ECI	1240 (15 studies)	Rebleeding ⇩ with BRTO (sHR 0.15), TIPS (sHR 0.49)	Ascites ⇧ with BRTO; HE ⇧ with TIPS	Endovascular therapies superior to ECI

EUS: Endoscopic ultrasound; ECI: Endoscopic cyanoacrylate injection; BRTO: Balloon-occluded retrograde transvenous obliteration; TIPS: Transjugular intrahepatic portosystemic shunt; NSBB: Non-selective beta-blockers; RR: Risk ratio; OR: Odds ratio; HE: Hepatic encephalopathy.